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Frost F, Dyce P, Ochota A, Pandya S, Clarke T, Walshaw MJ, Nazareth DS. Cystic fibrosis-related diabetes: optimizing care with a multidisciplinary approach. Diabetes Metab Syndr Obes 2019; 12:545-552. [PMID: 31118718 PMCID: PMC6499442 DOI: 10.2147/dmso.s180597] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and can be present in over 50% of adults with the disease. CFRD is associated with poorer clinical outcomes, including accelerated pulmonary function decline and excess morbidity. The management of CFRD is complex and differs from that of type 1 and type 2 diabetes mellitus such that clinicians responsible for the care of people with CFRD must work closely with colleagues across a number of different specialities and disciplines. This review aims to discuss why a multi-disciplinary approach is important and how it can be harnessed to optimize the care of people with CFRD.
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Affiliation(s)
- Freddy Frost
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Paula Dyce
- Cystic Fibrosis Related Diabetes Service, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Alicja Ochota
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Sejal Pandya
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Thomas Clarke
- Adult CF Centre, Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
| | - Martin J Walshaw
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
| | - Dilip S Nazareth
- Respiratory Medicine, Adult CF Centre, Liverpool Heart & Chest Hospital, LiverpoolL14 3PE, UK
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52
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Reynaud Q, Boudreau V, Touzet S, Desjardins K, Bourdy SP, Blond E, Berthiaume Y, Rabasa-Lhoret R, Durieu I. Glucose tolerance in Canadian and French cystic fibrosis adult patients. Sci Rep 2019; 9:4763. [PMID: 30894563 PMCID: PMC6427035 DOI: 10.1038/s41598-019-40592-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/04/2019] [Indexed: 12/16/2022] Open
Abstract
Cystic fibrosis (CF)-related diabetes is associated with increased mortality. We analysed the clinical and glycemic profiles of two cohorts of patients treated according to the same guidelines in France and Canada. To investigate incidence differences in phenotypic and glucose abnormalities and to explore the evolution over a 4-year follow-up period, two cohorts of 224 Canadian and 147 French adult CF patients (≥18 years) without treated CF-related diabetes (CFRD) were followed over a 4 year period. In each of these groups, we investigated the longitudinal relationship between glucose tolerance and pulmonary function. An annual 2-hour oral glucose tolerance test was performed: fasting blood glucose (G0) and 2-h blood glucose (G2) were measured. Patients were classified at inclusion according to their glucose tolerance status: Normal glucose tolerant, abnormal glucose tolerant or de novo CFRD. Age, sex ratio and proportion of F508del homozygous patients were not statistically different between both cohorts. Canadian patients had better pulmonary function (median %FEV1 (IQR): 71.0 (55.0–82.0) vs. 64.0 (40.0–78.0), p < 0.001) and greater body mass index (BMI; median BMI in kg/m2) (IQR) 21.1 (19.5–22.8) vs. 19.9 (18.4–21.4), p < 0.001). Glucose values: G0 (5.4 (5.0–5.9) vs. 4.8 (4.5–5.1) mmol/L, p < 0.001) and G2 (7.6 (5.8–9.7) vs. 6.5 (5.2–8.5) mmol/L, p = 0.001) were higher in the Canadian cohort translating into a higher incidence of de novo CFRD diagnosis (19.2 vs. 9.8%, p = 0.003). Decline in FEV1 over time was not different between patients according to glucose tolerance groups. Despite higher glucose levels and incidence of de novo CFRD, Canadian CF patients have a better lung function and a higher BMI than French patients. In spite of these differences between the cohorts, the decline in FEV1 in patients with abnormal glucose tolerance is similar between these groups.
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Affiliation(s)
- Quitterie Reynaud
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, F-69495, Pierre Bénite, France. .,Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, F-69003, Lyon, France.
| | - Valérie Boudreau
- Montreal Clinical Research Institute, Québec, Canada.,Université de Montréal, Département de nutrition et de Médecine, Montréal, Québec, Canada
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, F-69003, France.,Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, Lyon, France
| | | | - Stéphanie Poupon Bourdy
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, F-69003, France.,Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, Lyon, France
| | - Emilie Blond
- Service de Biochimie et Biologie Moléculaire, Hospices Civils de Lyon, F-69495, Pierre Bénite, France.,Université de Lyon, INSERM U1060, Laboratoire CarMen, F-69003, Lyon, France
| | - Yves Berthiaume
- Montreal Clinical Research Institute, Québec, Canada.,Cystic fibrosis clinic, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Québec, Canada.,Université de Montréal, Département de nutrition et de Médecine, Montréal, Québec, Canada.,Cystic fibrosis clinic, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Durieu
- Centre de référence Adulte de la Mucoviscidose, Service de médecine interne, Hospices civils de Lyon, F-69495, Pierre Bénite, France.,Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, F-69003, Lyon, France.,Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, F-69003, France.,Université de Lyon, Équipe d'Accueil Health Services and Performance Research (HESPER) 7425, Lyon, France
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53
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Effect of High Glucose on Human Alveolar Macrophage Phenotype and Phagocytosis of Mycobacteria. Lung 2018; 197:89-94. [PMID: 30474709 DOI: 10.1007/s00408-018-0181-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Diabetes mellitus (DBM) reduces immunological activity and increases susceptibility to various infections, including tuberculosis (TB). Human alveolar macrophage (hAM) functions are altered in DBM. METHODS To mimic hyperglycemic conditions in the lung alveolus, we co-cultured a hAM cell line (Daisy cell line) with human umbilical vein endothelial cells for 48 h in the presence of culture media alone, normal glucose (5 mM), and high glucose (22 mM). Using flow cytometry, immunophenotype characterization included cell surface markers CD 11c, CD14, CD16, CD86, CD163, CD169, CD206, CX3CR-1, CSF-1R, and matrix metalloproteinase-9 (MMP9). Phagocytic function was measured by immunofluorescence microscopy at 24 h after inoculation of cells with GFP-expressing Mycobacterium smegmatis. RESULTS Direct exposure of AMs to high glucose and exposure in the co-culture system yield different results for the same phenotypic markers. MMP9 expression was increased under both conditions. CD169 and CX3CR1 expressions were decreased when AMs were exposed directly to high glucose but increased under co-culture. Immunofluorescence assay revealed that phagocytosis decreased in AMs when directly exposed to increased glucose levels from 2.5 mM to normal glucose (5 mM), yet AMs under co-culture did not show decreased phagocytosis until concentrations were raised to 25 mM. CONCLUSION Alteration in the expression of certain receptors may contribute to defective sentinel function of AMs, promoting susceptibility to TB in a diabetic host. Variability in cell surface marker expression under direct glucose exposure compared to exposure via co-culture reveals that cell signaling between endothelial cells and AMs may play a crucial role in the phenotypic expression of AMs.
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54
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Brugha R, Wright M, Nolan S, Bridges N, Carr SB. Quantifying fluctuation in glucose levels to identify early changes in glucose homeostasis in cystic fibrosis. J Cyst Fibros 2018; 17:791-797. [DOI: 10.1016/j.jcf.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/21/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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55
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Frost F, Dyce P, Nazareth D, Malone V, Walshaw MJ. Continuous glucose monitoring guided insulin therapy is associated with improved clinical outcomes in cystic fibrosis-related diabetes. J Cyst Fibros 2018; 17:798-803. [DOI: 10.1016/j.jcf.2018.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
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Chan CL, Vigers T, Pyle L, Zeitler PS, Sagel SD, Nadeau KJ. Continuous glucose monitoring abnormalities in cystic fibrosis youth correlate with pulmonary function decline. J Cyst Fibros 2018; 17:783-790. [PMID: 29580828 PMCID: PMC6151303 DOI: 10.1016/j.jcf.2018.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND To characterize glucose patterns with continuous glucose monitoring (CGM) in cystic fibrosis (CF) and assess relationships between CGM and clinical outcomes. METHODS 110 CF youth and healthy controls (HC), 10-18 years, wore CGM up to 7 days. Correlations between CGM and lung function and BMI z-score change over the prior year were determined. RESULTS Multiple CGM measures were higher in CF Normal Glycemic (CFNG) youth versus HC (peak glucose, excursions >140 mg/dl/day, %time > 140 mg/dl, standard deviation (SD) and mean amplitude of glycemic excursions (MAGE)). Hypoglycemia was no different among groups. In CF, decline in FEV1% and FVC% correlated with maximum CGM glucose, excursions >200 mg/dl/day, SD, and MAGE. CONCLUSIONS CFNG youth have higher glucoses and glucose variability than HC on CGM. Higher and more variable glucoses correlate with lung function decline. Whether earlier treatment of CGM abnormalities improves lung function in CF requires further study.
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Affiliation(s)
- Christine L Chan
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Timothy Vigers
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Laura Pyle
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Philip S Zeitler
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Scott D Sagel
- Department of Pediatrics, Division of Pediatric Pulmonology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Kristen J Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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Brennan A, Beynon J. Dysglycaemia in CF - Why are investigating it, what should we measure and how should we treat it? J Cyst Fibros 2018; 17:690-691. [PMID: 30301615 DOI: 10.1016/j.jcf.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amanda Brennan
- Manchester Adult Cystic Fibrosis Centre, Manchester Foundation Trust, UK.
| | - Jennifer Beynon
- Manchester Adult Cystic Fibrosis Centre, Manchester Foundation Trust, UK
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Abstract
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasian patients. Continued advances have led to improved survival, and adults with CF now outnumber children. As our understanding of the disease improves, new therapies have emerged that improve the basic defect, enabling patient-specific treatment and improved outcomes. However, recurrent exacerbations continue to lead to morbidity and mortality, and new pathogens have been identified that may lead to worse outcomes. In addition, new complications, such as CF-related diabetes and increased risk of gastrointestinal cancers, are creating new challenges in management. For patients with end-stage disease, lung transplantation has remained one of the few treatment options, but challenges in identifying the most appropriate patients remain.
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Affiliation(s)
- Michael M Rey
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
| | - Michael P Bonk
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
| | - Denis Hadjiliadis
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; , ,
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Moran A, Pillay K, Becker D, Granados A, Hameed S, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Management of cystic fibrosis-related diabetes in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:64-74. [PMID: 30094886 DOI: 10.1111/pedi.12732] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - Dorothy Becker
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea Granados
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Shihab Hameed
- Department of Endocrinology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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60
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Mallia P, Webber J, Gill SK, Trujillo-Torralbo MB, Calderazzo MA, Finney L, Bakhsoliani E, Farne H, Singanayagam A, Footitt J, Hewitt R, Kebadze T, Aniscenko J, Padmanaban V, Molyneaux PL, Adcock IM, Barnes PJ, Ito K, Elkin SL, Kon OM, Cookson WO, Moffat MF, Johnston SL, Tregoning JS. Role of airway glucose in bacterial infections in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol 2018; 142:815-823.e6. [PMID: 29310905 PMCID: PMC6127032 DOI: 10.1016/j.jaci.2017.10.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have increased susceptibility to respiratory tract infection, which contributes to disease progression and mortality, but mechanisms of increased susceptibility to infection remain unclear. OBJECTIVES The aim of this study was to determine whether glucose concentrations were increased in airway samples (nasal lavage fluid, sputum, and bronchoalveolar lavage fluid) from patients with stable COPD and to determine the effects of viral infection on sputum glucose concentrations and how airway glucose concentrations relate to bacterial infection. METHODS We measured glucose concentrations in airway samples collected from patients with stable COPD and smokers and nonsmokers with normal lung function. Glucose concentrations were measured in patients with experimentally induced COPD exacerbations, and these results were validated in patients with naturally acquired COPD exacerbations. Relationships between sputum glucose concentrations, inflammatory markers, and bacterial load were examined. RESULTS Sputum glucose concentrations were significantly higher in patients with stable COPD compared with those in control subjects without COPD. In both experimental virus-induced and naturally acquired COPD exacerbations, sputum and nasal lavage fluid glucose concentrations were increased over baseline values. There were significant correlations between sputum glucose concentrations and sputum inflammatory markers, viral load, and bacterial load. Airway samples with higher glucose concentrations supported more Pseudomonas aeruginosa growth in vitro. CONCLUSIONS Airway glucose concentrations are increased in patients with stable COPD and further increased during COPD exacerbations. Increased airway glucose concentrations might contribute to bacterial infections in both patients with stable and those with exacerbated COPD. This has important implications for the development of nonantibiotic therapeutic strategies for the prevention or treatment of bacterial infection in patients with COPD.
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Affiliation(s)
- Patrick Mallia
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - Jessica Webber
- Cardiff University School of Medicine, UHW Main Building Heath Park Cardiff, Cardiff, United Kingdom
| | - Simren K Gill
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, St Mary's Campus, London, United Kingdom
| | | | - Maria Adelaide Calderazzo
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Lydia Finney
- Airways Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Eteri Bakhsoliani
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Hugo Farne
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Aran Singanayagam
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - Joseph Footitt
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Richard Hewitt
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tatiana Kebadze
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Julia Aniscenko
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Vijay Padmanaban
- Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - Philip L Molyneaux
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Adcock
- Airways Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Peter J Barnes
- Airways Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Kazihuro Ito
- Airways Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sarah L Elkin
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - Onn Min Kon
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - William O Cookson
- Molecular Genetics and Genomics Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Miriam F Moffat
- Molecular Genetics and Genomics Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; Imperial College Healthcare, National Health Service Trust, London, United Kingdom
| | - John S Tregoning
- Mucosal Infection and Immunity Group, Section of Virology, Imperial College London, St Mary's Campus, London, United Kingdom.
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Zorrón Mei Hsia Pu M, Gonçalves AC, Minnicucci WJ, Morcillo AM, Ribeiro JD, Ribeiro AF. Continuous glucose monitoring to evaluate glycaemic abnormalities in cystic fibrosis. Arch Dis Child 2018; 103:592-596. [PMID: 29378680 DOI: 10.1136/archdischild-2017-314250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to determine the glycaemic profile of patients with cystic fibrosis using a continuous glucose monitoring system (CGMS), and to evaluate the associations of glycaemic abnormalities with sex, age, pubertal stage, CFTR gene mutations, nutritional status, lung function, oral glucose tolerance test, glycated haemoglobin concentrations, fasting insulin concentrations, C peptide concentrations and exocrine pancreatic function. STUDY DESIGN This observational study evaluated CGMS data from 39 patients with cystic fibrosis who were treated at a referral centre. The patients were 10-19.9 years old, and were categorised according to whether they had normal results (27 patients) or glucose intolerance (12 patients) during the oral glucose tolerance test. RESULTS The maximum interstitial glucose concentration among individuals with normal oral glucose tolerance test results was 174.9±65.1 mg/dL (9.7-3.61 mmol/L), compared with 170.4±40.9 mg/dL (9.46-2.27 mmol/L) among individuals with glucose intolerance. The CGMS revealed that 18 of the 27 patients with normal oral glucose tolerance test results had peak interstitial glucose concentrations of >140 mg/dL (7.8 mmol/L), and that 4 of these individuals had peak levels of >200 mg/dL (11.1 mmol/L). None of the analysed clinical or laboratory characteristics predicted the occurrence of hyperglycaemic peaks on CGMS. CONCLUSIONS The present study revealed that CGMS could detect hyperglycaemia among patients with cystic fibrosis and 'normal' oral glucose tolerance test results, and that their clinical and laboratory characteristics were not useful in discerning between patients who did and did not exhibit these excursions.
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Affiliation(s)
| | | | | | - André Moreno Morcillo
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - José Dirceu Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Coriati A, Massé C, Ménard A, Bouvet GF, Berthiaume Y. Neutrophils as a Potential Source of Chitinase-3-like Protein 1 in Cystic Fibrosis. Inflammation 2018; 41:1631-1639. [DOI: 10.1007/s10753-018-0806-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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63
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Bridges N, Rowe R, Holt RIG. Unique challenges of cystic fibrosis-related diabetes. Diabet Med 2018; 35:1181-1188. [PMID: 29687501 DOI: 10.1111/dme.13652] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 01/24/2023]
Abstract
Individuals with cystic fibrosis and pancreatic insufficiency have a gradual decline in insulin secretion over time, which results in an increase in the prevalence of diabetes with age; up to 50% of adults with cystic fibrosis aged over 35 years have diabetes. Cystic fibrosis-related diabetes differs from Type 1 and Type 2 diabetes in several ways; there is a pattern of insulin deficiency with reduced and delayed insulin response to carbohydrates but a sparing of basal insulin that results in glucose abnormalities, which are frequently characterized by normal fasting glucose and postprandial hyperglycaemia. Insulin deficiency and hyperglycaemia, even at levels which do not reach the threshold for a diagnosis of diabetes, have an adverse impact on lung function and clinical status in people with cystic fibrosis. Although the risk of microvascular complications occurs as in other forms of diabetes, the main reason for treatment is to prevent deterioration in lung function and weight loss; treatment may therefore be required at an earlier stage than for other types of diabetes. Treatment is usually with insulin, but management needs to take into account all the other medical issues that arise in cystic fibrosis.
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Affiliation(s)
- N Bridges
- Chelsea and Westminster Hospital, London and the Royal Brompton Hospital, London, UK
| | - R Rowe
- University Hospital of South Manchester, Manchester, UK
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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64
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Airway Glucose Homeostasis. Chest 2018; 153:507-514. [DOI: 10.1016/j.chest.2017.05.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 01/19/2023] Open
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Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasian populations. Individuals with CF have seen significant increases in life expectancy in the last 60 years. As a result, previously rare complications are now coming to light. The most common of these is cystic fibrosis-related diabetes (CFRD), which affects 40-50% of CF adults. CFRD significantly impacts the pulmonary function and longevity of CF patients, yet a lack of consensus on the best methods to diagnose and treat CFRD remains. We begin by reviewing our understanding of the pathogenesis of CFRD, as emerging evidence shows the cystic fibrosis transmembrane conductance regulator (CFTR) also has important roles in the release of insulin and glucagon and in the protection of β cells from oxidative stress. We then discuss how current recommended methods of CFRD diagnosis are not appropriate, as continuous glucose monitoring becomes more effective, practical, and cost-effective. Finally, we evaluate emerging treatments which have narrowed the mortality gap within the CF patient group. In the future, pharmacological potentiators and correctors directly targeting CFTR show huge promise for both CFRD and the wider CF patient groups.
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Affiliation(s)
- Kayani Kayani
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Raihan Mohammed
- Faculty of Medicine, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Raihan Mohammed,
| | - Hasan Mohiaddin
- Faculty of Medicine, Imperial College London, London, United Kingdom
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66
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Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients. ENDOCRINOL DIAB NUTR 2018. [DOI: 10.1016/j.endien.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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67
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Lecube A, Simó R, Pallayova M, Punjabi NM, López-Cano C, Turino C, Hernández C, Barbé F. Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. Endocr Rev 2017; 38:550-573. [PMID: 28938479 DOI: 10.1210/er.2017-00173] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
Abstract
Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
| | - Rafael Simó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Maria Pallayova
- Department of Medicine, Weill Cornell Medicine.,Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain
| | - Cristina Hernández
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain.,Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain
| | - Ferran Barbé
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain
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68
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Clemente León M, Bilbao Gassó L, Moreno-Galdó A, Campos Martorrell A, Gartner Tizzano S, Yeste Fernández D, Carrascosa Lezcano A. Oral glucose tolerance test and continuous glucose monitoring to assess diabetes development in cystic fibrosis patients. ACTA ACUST UNITED AC 2017; 65:45-51. [PMID: 29137964 DOI: 10.1016/j.endinu.2017.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Patients with cystic fibrosis (CF) undergo a slow and progressive process toward diabetes. Oral glucose tolerance test (OGTT) is recommended to diagnose impaired glucose levels in these patients. Continuous glucose monitoring (CGM) measures glucose profiles under real-life conditions. OBJECTIVE To compare OGTT and CGM results in CF patients. METHODS Paired OGTT and 6-day CGM profiles (146.2±9.1h/patient) were performed in 30 CF patients aged 10-18 years. RESULTS According to OGTT, 14 patients had normal glucose tolerance (NGT), 14 abnormal glucose tolerance (AGT), and two cystic fibrosis-related diabetes (CFRD). In 27 patients (13 NGT, 13 AGT, 1 CFRD), CGM showed glucose values ranging from 140 to 200mg/dL during similar monitoring times (2%-14% with NGT, 1%-16.9% with AGT, and 3% with CFRD). Glucose peak levels ≥200mg/dL were seen in seven patients (3 NGT, 3 AGT, 1 CFRD). According to CGM, two patients had all glucose values under 140mg/dL (1 NGT, 1 AGT). Seventeen patients had glucose levels ranging from 140 to 200mg/dL (10 NGT, 6 AGT, 1 CFRD). Ten patients (3 NGT, 7 AGT) had glucose values ≥200mg/dL for ≤1% of the monitoring time and one (CFRD) for >1% of the monitoring time. CONCLUSIONS OGTT results did not agree with those of the CGM. CGM allows for diagnosis of glucose changes not detected by OGTT. Such changes may contribute to optimize pre-diabetes management in CF patients.
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Affiliation(s)
- María Clemente León
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain.
| | - Laura Bilbao Gassó
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Spain
| | - Antonio Moreno-Galdó
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Ariadna Campos Martorrell
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Silvia Gartner Tizzano
- Sección de Alergia Pediátrica, Neumología Pediátrica y Fibrosis quística, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Diego Yeste Fernández
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
| | - Antonio Carrascosa Lezcano
- Unidad de Endocrinología, Servicio de Pediatría, Hospital Vall d'Hebron, Grupo de Investigación Crecimiento y Desarrollo, Instituto Investigación Vall d'Hebron (VHIR), CIBER de Enfermedades Raras, Instituto Salud Carlos III, Universitat Autònoma de Barcelona, Spain
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69
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Continuous glucose monitoring in a cystic fibrosis patient to predict pulmonary exacerbation? J Cyst Fibros 2017. [DOI: 10.1016/j.jcf.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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70
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Ronan NJ, Elborn JS, Plant BJ. Current and emerging comorbidities in cystic fibrosis. Presse Med 2017; 46:e125-e138. [PMID: 28554721 DOI: 10.1016/j.lpm.2017.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023] Open
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) is expressed ubiquitously throughout the body. Thus, while respiratory manifestations dominate much of cystic fibrosis (CF) care, there are prominent multi-organ manifestations and comorbidities. In the general population, the number of comorbidities increases with aging. Few illnesses have experienced such a dramatic improvement in survival as CF, which has been transformed from an illness of childhood death to one of adult survival. Hence, as longevity increases in CF, it is paralleled by an increasing number of patients with multicomplex comorbidities availing of care from adult CF multi-disciplinary teams. This review gives an overview of the traditional CF associated comorbidities and those emerging in an aging adult cohort. While historically the treatment of CF focused on the consequences of CFTR dysfunction, the recent advent of CFTR modulators with the potential to enhance CFTR function represents an opportunity to potentially reverse or delay the development of some of the comorbidities associated with CF. Where evidence is available for the impact of CFTR modulatory therapy, namely ivacaftor on comorbidities in CF, this is highlighted.
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Affiliation(s)
- Nicola J Ronan
- Cork university hospital, university college Cork, Cork adult cystic fibrosis centre, HRB clinical research facility, Wilton,T12 DFK4 Cork, Ireland
| | - Joseph Stuart Elborn
- London and Queen's university Belfast, National heart and lung institute, Imperial College, Royal Brompton hospital, London, United Kingdom
| | - Barry J Plant
- Cork university hospital, university college Cork, Cork adult cystic fibrosis centre, HRB clinical research facility, Wilton,T12 DFK4 Cork, Ireland.
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71
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Lehoux Dubois C, Boudreau V, Tremblay F, Lavoie A, Berthiaume Y, Rabasa-Lhoret R, Coriati A. Association between glucose intolerance and bacterial colonisation in an adult population with cystic fibrosis, emergence of Stenotrophomonas maltophilia. J Cyst Fibros 2017; 16:418-424. [DOI: 10.1016/j.jcf.2017.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/17/2022]
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72
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Molina SA, Moriarty HK, Infield DT, Imhoff BR, Vance RJ, Kim AH, Hansen JM, Hunt WR, Koval M, McCarty NA. Insulin signaling via the PI3-kinase/Akt pathway regulates airway glucose uptake and barrier function in a CFTR-dependent manner. Am J Physiol Lung Cell Mol Physiol 2017; 312:L688-L702. [PMID: 28213469 PMCID: PMC5451595 DOI: 10.1152/ajplung.00364.2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
Cystic fibrosis-related diabetes is the most common comorbidity associated with cystic fibrosis (CF) and correlates with increased rates of lung function decline. Because glucose is a nutrient present in the airways of patients with bacterial airway infections and because insulin controls glucose metabolism, the effect of insulin on CF airway epithelia was investigated to determine the role of insulin receptors and glucose transport in regulating glucose availability in the airway. The response to insulin by human airway epithelial cells was characterized by quantitative PCR, immunoblot, immunofluorescence, and glucose uptake assays. Phosphatidylinositol 3-kinase/protein kinase B (Akt) signaling and cystic fibrosis transmembrane conductance regulator (CFTR) activity were analyzed by pharmacological and immunoblot assays. We found that normal human primary airway epithelial cells expressed glucose transporter 4 and that application of insulin stimulated cytochalasin B-inhibitable glucose uptake, consistent with a requirement for glucose transporter translocation. Application of insulin to normal primary human airway epithelial cells promoted airway barrier function as demonstrated by increased transepithelial electrical resistance and decreased paracellular flux of small molecules. This provides the first demonstration that airway cells express insulin-regulated glucose transporters that act in concert with tight junctions to form an airway glucose barrier. However, insulin failed to increase glucose uptake or decrease paracellular flux of small molecules in human airway epithelia expressing F508del-CFTR. Insulin stimulation of Akt1 and Akt2 signaling in CF airway cells was diminished compared with that observed in airway cells expressing wild-type CFTR. These results indicate that the airway glucose barrier is regulated by insulin and is dysfunctional in CF.
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Affiliation(s)
- Samuel A Molina
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia;
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Hannah K Moriarty
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel T Infield
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
| | - Barry R Imhoff
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
| | - Rachel J Vance
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Agnes H Kim
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jason M Hansen
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - William R Hunt
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Koval
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia
| | - Nael A McCarty
- Emory+Children's Center for Cystic Fibrosis and Airways Disease Research, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
- Division of Pulmonology, Allergy & Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; and
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73
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Ho TW, Huang CT, Ruan SY, Tsai YJ, Lai F, Yu CJ. Diabetes mellitus in patients with chronic obstructive pulmonary disease-The impact on mortality. PLoS One 2017; 12:e0175794. [PMID: 28410410 PMCID: PMC5391945 DOI: 10.1371/journal.pone.0175794] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/31/2017] [Indexed: 12/16/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. There is evidence to support a connection between COPD and diabetes mellitus (DM), another common medical disorder. However, additional research is required to improve our knowledge of these relationships and their possible implications. In this study, we investigated the impact of DM on patient outcomes through the clinical course of COPD. Methods We conducted a cohort study in patients from the Taiwan Longitudinal Health Insurance Database between 2000 and 2013. Patients with COPD were identified and assessed for pre-existing and incident DM. A Cox proportional hazards model was built to identify factors associated with incident DM and to explore the prognostic effects of DM on COPD patients. A propensity score method was used to match COPD patients with incident DM to controls without incident DM. Results Pre-existing DM was present in 332 (16%) of 2015 COPD patients who had a significantly higher hazard ratio (HR) [1.244, 95% confidence interval (CI) 1.010–1.532] for mortality than that of the COPD patients without pre-existing DM. During the 10-year follow-up period, 304 (19%) of 1568 COPD patients developed incident DM; comorbid hypertension (HR, 1.810; 95% CI, 1.363–2.403), cerebrovascular disease (HR, 1.517; 95% CI, 1.146–2.008) and coronary artery disease (HR, 1.408; 95% CI 1.089–1.820) were significant factors associated with incident DM. Survival was worse for the COPD patients with incident DM than for the matched controls without incident DM (Log-rank, p = 0.027). Conclusions DM, either pre-existing or incident, was associated with worse outcomes in COPD patients. Targeted surveillance and management of DM may be important in clinical care of the COPD population.
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Affiliation(s)
- Te-Wei Ho
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chun-Ta Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Sheng-Yuan Ruan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ju Tsai
- Graduate Institute of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Zheng Y, Zhang X, Wang X, Wang L, Zhang J, Yin Y. ComE, an Essential Response Regulator, Negatively Regulates the Expression of the Capsular Polysaccharide Locus and Attenuates the Bacterial Virulence in Streptococcus pneumoniae. Front Microbiol 2017; 8:277. [PMID: 28326061 PMCID: PMC5339220 DOI: 10.3389/fmicb.2017.00277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/09/2017] [Indexed: 11/25/2022] Open
Abstract
The capsular polysaccharide (CPS) of Streptococcus pneumoniae is the main virulence factors required for effective colonization and invasive disease. The capacity to regulate CPS production at the transcriptional level is critical for the survival of S. pneumoniae in different host niches, but little is known about the transcription regulators of cps locus. In the present study, we isolated and identified the response regulator ComE, the master competence switch in transformation of S. pneumoniae, as a transcriptional regulator of cps locus by DNA affinity chromatography-pulldown, MALDI-TOF mass spectrometry (MS) and electrophoretic mobility shift assay (EMSA). Our results showed that phosphorylated mimetic of ComE (ComED58E) bound specifically to the cps locus prompter in vitro, and phosphorylated ComE negatively impacted both cps locus transcription and CPS production attenuating the pneumococcal virulence in vivo. Compared with D39-WT strain, D39ΔcomE mutant exhibited much thicker capsule, attenuated nasopharyngeal colonization and enhanced virulence in both pneumonia and bacteremia models of Balb/c mice. Furthermore, it was demonstrated that CSP-ComD/E competence system involved in regulating negatively the CPS production during the progress of transformation in D39. Our CSP1 induction experiment results showed that the expression of ComE in D39-WT strain increased powerfully by 120% after 10 min of CSP1 induction, but the CPS production in D39-WT strain decreased sharply by 67.1% after 15 min of CSP1 induction. However, the CPS production in D39ΔcomE mutant was almost constant during the whole stage of induction. Additionally, we found that extracellular glucose concentration could affect both the expression of ComE and CPS production of D39 in vitro. Taken together, for the first time, we report that ComE, as a transcriptional regulator of cps locus, plays an important role in transcriptional regulation of cps locus and capsular production level.
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Affiliation(s)
- Yuqiang Zheng
- Department of Medicine Laboratory, Childrens Hospital of Chongqing Medical University Chongqing, China
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University Chongqing, China
| | - Xiaofang Wang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University Chongqing, China
| | - Libin Wang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University Chongqing, China
| | - Jinghui Zhang
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University Chongqing, China
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University Chongqing, China
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BEAUDOIN NADIA, BOUVET GUILLAUMEF, CORIATI ADÈLE, RABASA-LHORET RÉMI, BERTHIAUME YVES. Combined Exercise Training Improves Glycemic Control in Adult with Cystic Fibrosis. Med Sci Sports Exerc 2017; 49:231-237. [DOI: 10.1249/mss.0000000000001104] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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76
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Peckham D, Scambler T, Savic S, McDermott MF. The burgeoning field of innate immune-mediated disease and autoinflammation. J Pathol 2016; 241:123-139. [PMID: 27682255 DOI: 10.1002/path.4812] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 01/07/2023]
Abstract
Immune-mediated autoinflammatory diseases are occupying an increasingly prominent position among the pantheon of debilitating conditions that afflict humankind. This review focuses on some of the key developments that have occurred since the original description of autoinflammatory disease in 1999, and focuses on underlying mechanisms that trigger autoinflammation. The monogenic autoinflammatory disease range has expanded considerably during that time, and now includes a broad spectrum of disorders, including relatively common conditions such as cystic fibrosis and subsets of systemic lupus erythematosus. The innate immune system also plays a key role in the pathogenesis of complex inflammatory disorders. We have proposed a new nomenclature to accommodate the rapidly increasing number of monogenic disorders, which predispose to either autoinflammation or autoimmunity or, indeed, combinations of both. This new terminology also encompasses a wide spectrum of genetically determined autoinflammatory diseases, with variable clinical manifestations of immunodeficiency and immune dysregulation/autoimmunity. We also explore some of the ramifications of the breakthrough discovery of the physiological role of pyrin and the search for identifiable factors that may serve to trigger attacks of autoinflammation. The evidence that pyrin, as part of the pyrin inflammasome, acts as a sensor of different inactivating bacterial modification Rho GTPases, rather than interacting directly with these microbial products, sets the stage for a better understanding of the role of microorganisms and infections in the autoinflammatory disorders. Finally, we discuss some of the triggers of autoinflammation as well as potential therapeutic interventions aimed at enhancing autophagy and proteasome degradation pathways. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Daniel Peckham
- Leeds Centre for Cystic Fibrosis, St James's University Hospital, Leeds, UK
| | - Thomas Scambler
- National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit (NIHR-LMBRU) and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK
| | - Sinisa Savic
- National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit (NIHR-LMBRU) and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK.,Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, UK
| | - Michael F McDermott
- National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit (NIHR-LMBRU) and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Wellcome Trust Brenner Building, St James's University Hospital, Leeds, UK
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Screening for Cystic Fibrosis-Related Diabetes: Matching Pathophysiology and Addressing Current Challenges. Can J Diabetes 2016; 40:466-470. [DOI: 10.1016/j.jcjd.2016.08.221] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/13/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022]
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78
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Pu MZMH, Christensen-Adad FC, Gonçalves AC, Minicucci WJ, Ribeiro JD, Ribeiro AF. Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26994743 PMCID: PMC5178124 DOI: 10.1016/j.rppede.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: To elucidate whether insulin is effective or not in patients with cystic fibrosis before the diabetes mellitus phase. Data source: The study was performed according to the Prisma method between August and September 2014, using the PubMed, Embase, Lilacs and SciELO databases. Prospective studies published in English, Portuguese and Spanish from 2002 to 2014, evaluating the effect of insulin on weight parameters, body mass index and pulmonary function in patients with cystic fibrosis, with a mean age of 17.37 years before the diabetes mellitus phase were included. Data synthesis: Eight articles were identified that included 180 patients undergoing insulin use. Sample size ranged from 4 to 54 patients, with a mean age ranging from 12.4 to 28 years. The type of follow-up, time of insulin use, the dose and implementation schedule were very heterogeneous between studies. Conclusions: There are theoretical reasons to believe that insulin has a beneficial effect in the studied population. The different methods and populations assessed in the studies do not allow us to state whether early insulin therapy should or should not be carried out in patients with cystic fibrosis prior to the diagnosis of diabetes. Therefore, studies with larger samples and insulin use standardization are required.
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CpsR, a GntR family regulator, transcriptionally regulates capsular polysaccharide biosynthesis and governs bacterial virulence in Streptococcus pneumoniae. Sci Rep 2016; 6:29255. [PMID: 27386955 PMCID: PMC4937376 DOI: 10.1038/srep29255] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/14/2016] [Indexed: 11/18/2022] Open
Abstract
Transcriptional regulation of capsule expression is critical for pneumococcal transition from carriage to infection, yet the underlying mechanism remains incompletely understood. Here, we describe the regulation of capsular polysaccharide, one of the most important pneumococcal virulence factor by a GntR family regulator, CpsR. Electrophoretic mobility-shift assays have shown the direct interaction between CpsR and the cps promoter (cpsp), and their interaction could be competitively interfered by glucose. DNase I footprinting assays localized the binding site to a region −146 to −114 base pairs relative to the transcriptional start site of the cps locus in S. pneumoniae D39. We found that CpsR negatively controlled the transcription of the cps locus and hence CPS production, which was confirmed by fine-tuning expression of CpsR in a ΔcpsR complemented strain. Increased expression of CpsR in complemented strain led to a decreased resistance to the whole-blood-mediated killing, suggesting a protective role for CpsR-cpsp interaction in the establishment of invasive infection. Finally, animal experiments showed that CpsR-cpsp interaction was necessary for both pneumococcal colonization and invasive infection. Taken together, our results provide a thorough insight into the regulation of capsule production mediated by CpsR and its important roles in pneumococcal pathogenesis.
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Koivula FNM, McClenaghan NH, Harper AGS, Kelly C. Islet-intrinsic effects of CFTR mutation. Diabetologia 2016; 59:1350-1355. [PMID: 27033560 PMCID: PMC4901107 DOI: 10.1007/s00125-016-3936-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/26/2016] [Indexed: 12/17/2022]
Abstract
Cystic fibrosis-related diabetes (CFRD) is the most significant extra-pulmonary comorbidity in cystic fibrosis (CF) patients, and accelerates lung decline. In addition to the traditional view that CFRD is a consequence of fibrotic destruction of the pancreas as a whole, emerging evidence may implicate a role for cystic fibrosis transmembrane-conductance regulator (CFTR) in the regulation of insulin secretion from the pancreatic islet. Impaired first-phase insulin responses and glucose homeostasis have also been reported in CF patients. CFTR expression in both human and mouse beta cells has been confirmed, and recent studies have shown differences in endocrine pancreatic morphology from birth in CF. Recent experimental evidence suggests that functional CFTR channels are required for insulin exocytosis and the regulation of membrane potential in the pancreatic beta cell, which may account for the impairments in insulin secretion observed in many CF patients. These novel insights suggest that the pathogenesis of CFRD is more complicated than originally thought, with implications for diabetes treatment and screening in the CF population. This review summarises recent emerging evidence in support of a primary role for endocrine pancreatic dysfunction in the development of CFRD. Summary • CF is an autosomal recessive disorder caused by mutations in the CFTR gene • The vast majority of morbidity and mortality in CF results from lung disease. However CFRD is the largest extra-pulmonary co-morbidity and rapidly accelerates lung decline • Recent experimental evidence shows that functional CFTR channels are required for normal patterns of first phase insulin secretion from the pancreatic beta cell • Current clinical recommendations suggest that insulin is more effective than oral glucose-lowering drugs for the treatment of CFRD. However, the emergence of CFTR corrector and potentiator drugs may offer a personalised approach to treating diabetes in the CF population.
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Affiliation(s)
- Fiona N Manderson Koivula
- Northern Ireland Centre for Stratified Medicine, University of Ulster, C-TRIC, Altnagelvin Hospital Site, Glenshane Road, Derry/Londonderry, BT47 6SB, Northern Ireland, UK
| | - Neville H McClenaghan
- School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UK
| | - Alan G S Harper
- Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Stoke-on-Trent, UK
| | - Catriona Kelly
- Northern Ireland Centre for Stratified Medicine, University of Ulster, C-TRIC, Altnagelvin Hospital Site, Glenshane Road, Derry/Londonderry, BT47 6SB, Northern Ireland, UK.
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81
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Prentice B, Hameed S, Verge CF, Ooi CY, Jaffe A, Widger J. Diagnosing cystic fibrosis-related diabetes: current methods and challenges. Expert Rev Respir Med 2016; 10:799-811. [DOI: 10.1080/17476348.2016.1190646] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
| | - Shihab Hameed
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Endocrinology, Sydney Children’s Hospital, Randwick, Australia
| | - Charles F. Verge
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Endocrinology, Sydney Children’s Hospital, Randwick, Australia
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
- Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
| | - John Widger
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Randwick, Australia
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82
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Belle-van Meerkerk G, de Valk HW, Stam-Slob MC, Teding van Berkhout F, Zanen P, van de Graaf EA. Cystic Fibrosis-Related Diabetes with strict glycaemic control is not associated with frequent intravenous antibiotics use for pulmonary infections. Diabetes Res Clin Pract 2016; 116:230-6. [PMID: 27321340 DOI: 10.1016/j.diabres.2016.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/14/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
AIMS Pulmonary infections are more frequent in and associated with higher mortality in Cystic Fibrosis-Related Diabetes (CFRD) patients compared to CF patients without CFRD. Hyperglycaemia can lead to a higher vulnerability for infections. Aim of the study was to test whether the infection rate in well-controlled CFRD patients was similar to that in CF patients without CFRD. METHODS This is a retrospective six-year cohort analysis on a consecutive series of 138 CF patients. They were categorized in two groups with CFRD or without CFRD. Pulmonary infection frequency was defined as the number of intravenous (IV) antibiotic treatments. Clinical factors associated with infection frequency were collected. RESULTS CFRD was diagnosed in 54 (39%) CF patients of whom 44 (81%) achieved target value for glycaemic control (HbA1c 7.0% (⩽53mmol/mol)). Median frequency of IV antibiotics was 0 without CFRD and 3 episodes in patients with CFRD (rate ratio (RR) 2.9 (95% CI 1.6-5.2)). Multivariate analysis showed that frequency of IV antibiotics was significantly related to Pseudomonas aeruginosa colonization (RR 3.7) and lower lung function at baseline (RR 0.97) but not to CFRD by itself. CONCLUSIONS In this cohort with overall strict glycaemic control, the frequency of IV antibiotics use was related to chronic infection and impaired lung function at baseline, but not to CFRD by itself. Although this study in itself does not prove beneficial effect of strict glycaemic control, it does emphasize the potential role of glycaemic control on infection frequency in CF patients.
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Affiliation(s)
- G Belle-van Meerkerk
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - H W de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - M C Stam-Slob
- Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F Teding van Berkhout
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - P Zanen
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - E A van de Graaf
- Department of Respiratory Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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83
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Coriati A, Ziai S, Lavoie A, Berthiaume Y, Rabasa-Lhoret R. The 1-h oral glucose tolerance test glucose and insulin values are associated with markers of clinical deterioration in cystic fibrosis. Acta Diabetol 2016. [PMID: 26215312 DOI: 10.1007/s00592-015-0791-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Cystic fibrosis (CF) is associated with the emergence of CF-related diabetes (CFRD). CFRD is associated with increased risk of accelerated weight and/or lung function loss (clinical degradation). Data in the CF pediatric population reported an association between higher 60-min oral glucose tolerance test (OGTT) plasma glucose values and reduced lung function. Our objective was to evaluate the relationship between the 60-min OGTT insulin and glucose values and markers of clinical degradation in adult patients with CF. METHODS This study was based on an ongoing observational cohort of CF adult patients (≥18 years). All patients underwent a 2-h OGTT with 30-min interval sample measurements. Plasma insulin and glucose levels were measured. Adult patients (N = 240) were categorized based on the 60-min OGTT median values of glucose (G60, 11.0 mmol/L) and/or insulin (I60, 43.4 μU/mL). RESULTS A negative association was observed between the 60-min OGTT glucose value and pulmonary function (FEV1; P = 0.001), whereas 60-min OGTT insulin values were positively associated with BMI (P = 0.004). Patients with high G60 values displayed lower FEV1 than patients with low G60 values (P = 0.025). Patients with higher I60 values demonstrated higher values of both FEV1 (P = 0.022) and BMI (P = 0.003) than patients with low I60 values. More importantly, when adjusting for BMI, the difference in FEV1 between both groups no longer existed (P = 0.166). CONCLUSIONS Both insulin and glucose values at 60-min OGTT are associated with indicators of clinical degradation in adult patients with CF. Future prospective analyses are essential in establishing the clinical utility of these indicators.
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Affiliation(s)
- Adèle Coriati
- Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
- Department of Nutrition, Université de Montréal, Montréal, QC, H3T 1A8, Canada.
| | - Sophie Ziai
- Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada
- Department of Nutrition, Université de Montréal, Montréal, QC, H3T 1A8, Canada
| | - Annick Lavoie
- Cystic Fibrosis Clinic of the Centre hospitalier de l'Université de Montréal, Montréal, QC, H2W 1T8, Canada
| | - Yves Berthiaume
- Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada
- Cystic Fibrosis Clinic of the Centre hospitalier de l'Université de Montréal, Montréal, QC, H2W 1T8, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, H3T 1J4, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada
- Department of Nutrition, Université de Montréal, Montréal, QC, H3T 1A8, Canada
- Cystic Fibrosis Clinic of the Centre hospitalier de l'Université de Montréal, Montréal, QC, H2W 1T8, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, H3T 1J4, Canada
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84
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Limoli DH, Yang J, Khansaheb MK, Helfman B, Peng L, Stecenko AA, Goldberg JB. Staphylococcus aureus and Pseudomonas aeruginosa co-infection is associated with cystic fibrosis-related diabetes and poor clinical outcomes. Eur J Clin Microbiol Infect Dis 2016; 35:947-53. [DOI: 10.1007/s10096-016-2621-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/04/2016] [Indexed: 12/27/2022]
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85
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Using HbA1c as a screening tool for Cystic Fibrosis Related Diabetes. J Cyst Fibros 2016; 15:263-4. [DOI: 10.1016/j.jcf.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/15/2015] [Indexed: 11/18/2022]
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86
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Pu MZMH, Christensen-Adad FC, Gonçalves AC, Minicucci WJ, Ribeiro JD, Ribeiro AF. Insulin therapy in patients with cystic fibrosis in the pre-diabetes stage: a systematic review. REVISTA PAULISTA DE PEDIATRIA 2016; 34:367-73. [PMID: 26994743 DOI: 10.1016/j.rpped.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/14/2015] [Accepted: 12/01/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To elucidate whether insulin is effective or not in patients with cystic fibrosis before the diabetes mellitus phase. DATA SOURCE The study was performed according to the Prisma method between August and September 2014, using the PubMed, Embase, Lilacs and SciELO databases. Prospective studies published in English, Portuguese and Spanish from 2002 to 2014, evaluating the effect of insulin on weight parameters, body mass index and pulmonary function in patients with cystic fibrosis, with a mean age of 17.37 years before the diabetes mellitus phase were included. DATA SYNTHESIS Eight articles were identified that included 180 patients undergoing insulin use. Sample size ranged from 4 to 54 patients, with a mean age ranging from 12.4 to 28 years. The type of follow-up, time of insulin use, the dose and implementation schedule were very heterogeneous between studies. CONCLUSIONS There are theoretical reasons to believe that insulin has a beneficial effect in the studied population. The different methods and populations assessed in the studies do not allow us to state whether early insulin therapy should or should not be carried out in patients with cystic fibrosis prior to the diagnosis of diabetes. Therefore, studies with larger samples and insulin use standardization are required.
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Affiliation(s)
| | | | | | - Walter José Minicucci
- Faculdade de Ciências Médicas, Universidade de Campinas (Unicamp), Campinas, SP, Brasil
| | - José Dirceu Ribeiro
- Faculdade de Ciências Médicas, Universidade de Campinas (Unicamp), Campinas, SP, Brasil
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87
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Yu H, Yang J, Zhou X, Xiao Q, Lü Y, Xia L. High glucose induces dysfunction of airway epithelial barrier through down-regulation of connexin 43. Exp Cell Res 2016; 342:11-9. [PMID: 26902399 DOI: 10.1016/j.yexcr.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
The airway epithelium is a barrier to the inhaled antigens and pathogens. Connexin 43 (Cx43) has been found to play critical role in maintaining the function of airway epithelial barrier and be involved in the pathogenesis of the diabetic retinal vasculature, diabetes nephropathy and diabetes skin. Hyperglycemia has been shown to be an independent risk factor for respiratory infections. We hypothesize that the down-regulation of Cx43 induced by HG alters the expression of tight junctions (zonula occludens-1 (ZO-1) and occludin) and contributes to dysfunction of airway epithelial barrier, and Cx43 plays a critical role in the process in human airway epithelial cells (16 HBE). We show that high glucose (HG) decreased the expression of ZO-1 and occludin, disassociated interaction between Cx43 and tight junctions, and then increased airway epithelial transepithelial electrical resistance (TER) and permeability by down-regulation of Cx43 in human airway epithelial cells. These observations demonstrate an important role for Cx43 in regulating HG-induced dysfunction of airway epithelial barrier. These findings may bring new insights into the molecular pathogenesis of pulmonary infection related to diabetes mellitus and lead to novel therapeutic intervention for the dysfunction of airway epithelial barrier in chronic inflammatory airway diseases.
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Affiliation(s)
- Hongmei Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Juan Yang
- Division of Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangdong Zhou
- Division of Respiratory Medicine, The Affiliated Hospital of Hainan Medical College, Hainan, China
| | - Qian Xiao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xia
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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88
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Patkee WRA, Carr G, Baker EH, Baines DL, Garnett JP. Metformin prevents the effects of Pseudomonas aeruginosa on airway epithelial tight junctions and restricts hyperglycaemia-induced bacterial growth. J Cell Mol Med 2016; 20:758-64. [PMID: 26837005 PMCID: PMC4864950 DOI: 10.1111/jcmm.12784] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022] Open
Abstract
Lung disease and elevation of blood glucose are associated with increased glucose concentration in the airway surface liquid (ASL). Raised ASL glucose is associated with increased susceptibility to infection by respiratory pathogens including Staphylococcus aureus and Pseudomonas aeruginosa. We have previously shown that the anti‐diabetes drug, metformin, reduces glucose‐induced S. aureus growth across in vitro airway epithelial cultures. The aim of this study was to investigate whether metformin has the potential to reduce glucose‐induced P. aeruginosa infections across airway epithelial (Calu‐3) cultures by limiting glucose permeability. We also explored the effect of P. aeruginosa and metformin on airway epithelial barrier function by investigating changes in tight junction protein abundance. Apical P. aeruginosa growth increased with basolateral glucose concentration, reduced transepithelial electrical resistance (TEER) and increased paracellular glucose flux. Metformin pre‐treatment of the epithelium inhibited the glucose‐induced growth of P. aeruginosa, increased TEER and decreased glucose flux. Similar effects on bacterial growth and TEER were observed with the AMP activated protein kinase agonist, 5‐aminoimidazole‐4‐carboxamide ribonucleotide. Interestingly, metformin was able to prevent the P. aeruginosa‐induced reduction in the abundance of tight junction proteins, claudin‐1 and occludin. Our study highlights the potential of metformin to reduce hyperglycaemia‐induced P. aeruginosa growth through airway epithelial tight junction modulation, and that claudin‐1 and occludin could be important targets to regulate glucose permeability across airway epithelia and supress bacterial growth. Further investigation into the mechanisms regulating metformin and P. aeruginosa action on airway epithelial tight junctions could yield new therapeutic targets to prevent/suppress hyperglycaemia‐induced respiratory infections, avoiding the use of antibiotics.
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Affiliation(s)
| | - Georgina Carr
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Emma H Baker
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Deborah L Baines
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - James P Garnett
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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89
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Bilodeau C, Bardou O, Maillé É, Berthiaume Y, Brochiero E. Deleterious impact of hyperglycemia on cystic fibrosis airway ion transport and epithelial repair. J Cyst Fibros 2016; 15:43-51. [DOI: 10.1016/j.jcf.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 02/08/2023]
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90
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Lavie M, Fisher D, Vilozni D, Forschmidt R, Sarouk I, Kanety H, Hemi R, Efrati O, Modan-Moses D. Glucose intolerance in cystic fibrosis as a determinant of pulmonary function and clinical status. Diabetes Res Clin Pract 2015; 110:276-84. [PMID: 26508676 DOI: 10.1016/j.diabres.2015.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/27/2015] [Accepted: 10/02/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cystic fibrosis related diabetes (CFRD) is associated with a decrease in pulmonary function and nutritional status. We investigated the clinical significance of impaired glucose tolerance (IGT) in cystic fibrosis (CF) patients. METHODS Fifty-five CF patients (aged 22.8 ± 9.2 years, 29 males, mean FEV1 67.9 ± 22% predicted, mean BMI-SDS -0.23 ± 1.1) underwent a 2-h Oral Glucose Tolerance Test (OGTT) with 30-min interval measurements of glucose and insulin. Additional clinical and laboratory data were obtained from the medical charts. RESULTS Thirty-eight participants (69%) had normal glucose tolerance (NGT), 13 (23.7%) had IGT, and 4 (7.3%) had newly diagnosed CFRD. Compared to patients with NGT, patients with IGT had significantly lower BMI-SDS (-1.1 ± 0.8 vs. 0.1 ± 1.1, p<0.001), mean FEV1 (57 ± 19 vs. 74 ± 21% predicted, p<0.01), and albumin (3.9 ± 0.3 vs. 4.3 ± 0.2g/dl, p=0.004), and higher fibrinogen (376 ± 56 vs. 327 ± 48 g/dl, p=0.02). Patients with IGT had impaired β-cell function, with reduced first phase insulin secretion, a delayed insulin peak, and significantly lower total insulin secretion, HOMA-%B and insulinogenic index. Seven patients had HbA1c in the "diabetic" range (≥6.5%; 47.5 mmol/mol), however, HbA1c was not a sensitive or specific marker of glucose tolerance status. CONCLUSIONS IGT in CF patients is associated with increased inflammation and decreased nutritional status and pulmonary function.
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Affiliation(s)
- Moran Lavie
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1).
| | - Dor Fisher
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Rinat Forschmidt
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Hannah Kanety
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Rina Hemi
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Ori Efrati
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
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91
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Abstract
PURPOSE OF REVIEW This review will outline the screening, diagnosis and management of cystic fibrosis related diabetes (CFRD). It will also discuss advances in the detection of early glucose abnormalities, their clinical significance and the emerging role for early insulin therapy. RECENT FINDINGS Before the onset of diabetes (as currently defined), patients with cystic fibrosis (CF) display glucose abnormalities, detectable either by 30-minutely sampled oral glucose tolerance testing (OGTT), or by continuous ambulatory interstitial glucose monitoring (CGM). These early glucose abnormalities are associated with the presence of glucose in airway fluid, potentially promoting the growth of airway pathogens and contributing to the progression of respiratory disease. Progressive insulin deficiency underlies these glucose abnormalities, and insulin deficiency also causes catabolism. Pilot studies of once-daily insulin therapy in the early stages of insulin deficiency show improved lung function and weight gain (important predictors of survival in CF). SUMMARY Early stages of insulin deficiency may be contributing to catabolism and deteriorating lung function in CF. It is plausible that early insulin therapy may prevent this deterioration, a view supported by pilot studies. Randomized controlled trials of early insulin therapy will now determine whether insulin therapy should be commenced earlier than current practice in CF.
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92
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Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D, Minchev D, Marinova D. Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease. PeerJ 2015; 3:e1068. [PMID: 26157632 PMCID: PMC4493698 DOI: 10.7717/peerj.1068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/10/2015] [Indexed: 12/14/2022] Open
Abstract
Introduction. The metabolic syndrome (MS) affects 21-53% of patients with chronic obstructive pulmonary disease (COPD) with a higher prevalence in the early stages of COPD, with results being highly variable between studies. MS may also affect natural course of COPD-number of exacerbations, quality of life and lung function. Aim. To examine the prevalence of MS and its correlation with comorbidities and COPD characteristics in patients with COPD admitted for exacerbation. Material and methods. 152 patients with COPD admitted for exacerbation were studied for presence of MS. All of them were also assessed for vitamin D status and diabetes mellitus type 2 (DM). Data were gathered for smoking status and exacerbations during the last year. All patients completed CAT (COPD assessment test) and mMRC (Modified Medical Research Council Dyspnea scale) questionnaires and underwent spirometry. Duration of current hospital stay was recorded. Results. 25% of patients have MS. 23.1% of the male and 29.5% of the female patients have MS (p > 0.05). The prevalence of MS in this study is significantly lower when compared to a national representative study (44.6% in subjects over 45 years). 69.1% of all patients and 97.4% from MS patients have arterial hypertension. The presence of MS is associated with significantly worse cough and sleep (1st and 7th CAT questions; p = 0.002 and p = 0.001 respectively) and higher total CAT score (p = 0.017). Average BMI is 27.31. None of the patients have MS and BMI <25. There is a correlation between the presence of MS and DM (p = 0.008) and with the number of exacerbations in the last year (p = 0.015). There is no correlation between the presence of MS and the pulmonary function. Conclusion. This study among hospitalized COPD patients finds comparable but relatively low prevalence of MS (25%) compared to previously published data (21-53%) and lower prevalence compared to general population (44.6%). MS may impact quality of life and the number of exacerbations of COPD. Having in mind that MS is more common in the early stages and decreases with COPD progression, the COPD patients admitted for exacerbation may be considered as having advanced COPD.
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Affiliation(s)
- Evgeni Mekov
- Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria
| | - Yanina Slavova
- Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria
| | - Adelina Tsakova
- Central Clinical Laboratory, Medical University—Sofia, Sofia, Bulgaria
| | - Marianka Genova
- Central Clinical Laboratory, Medical University—Sofia, Sofia, Bulgaria
| | - Dimitar Kostadinov
- Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria
| | - Delcho Minchev
- Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria
| | - Dora Marinova
- Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria
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93
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Jørgensen KM, Wassermann T, Johansen HK, Christiansen LE, Molin S, Høiby N, Ciofu O. Diversity of metabolic profiles of cystic fibrosis Pseudomonas aeruginosa during the early stages of lung infection. MICROBIOLOGY-SGM 2015; 161:1447-62. [PMID: 25873584 DOI: 10.1099/mic.0.000093] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pseudomonas aeruginosa is the dominant pathogen infecting the airways of cystic fibrosis (CF) patients. During the intermittent colonization phase, P. aeruginosa resembles environmental strains but later evolves to the chronic adapted phenotype characterized by resistance to antibiotics and mutations in the global regulator genes mucA, lasR and rpoN. Our aim was to understand the metabolic changes occurring over time and between niches of the CF airways. By applying Phenotype MicroArrays, we investigated changes in the carbon and nitrogen catabolism of subsequently clonally related mucoid and non-mucoid (NM) lung and sinus P. aeruginosa isolates from 10 CF patients (five intermittently colonized/five chronically infected). We found the most pronounced catabolic changes for the early/late NM isolate comparisons, with respiratory reduction seen for all chronically infecting isolates and two intermittently colonizing isolates. Fewer differences were observed between sinus and lung isolates, showing a higher degree of isolate similarity between these two niches. Modest respiratory changes were seen for the early isolate/PAO1 comparisons, indicating colonization with environmental isolates. Assignment of metabolic pathways via the KEGG database showed a prevalence of substrates involved in the metabolism of Ala, Asp and Glu, d-Ala, and Arg and Pro. In conclusion, extensive heterogeneity in the metabolic profiles of the P. aeruginosa isolates was observed from the initial stages of the infection, showing a rapid diversification of the bacteria in the heterogeneous environment of the lung. Metabolic reduction seems to be a common trait and therefore an adaptive phenotype, though it can be reached via multiple metabolic pathways.
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Affiliation(s)
- Karin Meinike Jørgensen
- 1 Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Denmark
| | - Tina Wassermann
- 2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Helle Krogh Johansen
- 2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark 3 The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Hørsholm, Denmark
| | - Lasse Engbo Christiansen
- 4 Department of Informatics and Mathematical Modelling, Technical University of Denmark, Denmark
| | - Søren Molin
- 3 The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Hørsholm, Denmark 5 Center for Systems Biology, Technical University of Denmark, Denmark
| | - Niels Høiby
- 1 Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Denmark 2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Oana Ciofu
- 1 Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Denmark
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94
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Hatten KM, Palmer JN, Lee RJ, Adappa ND, Kennedy DW, Cohen NA. Corticosteroid use does not alter nasal mucus glucose in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2015; 152:1140-4. [PMID: 25820586 DOI: 10.1177/0194599815577567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/24/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate nasal mucus glucose concentrations in patients with and without chronic rhinosinusitis and determine if corticosteroid therapy alters mucus glucose. STUDY DESIGN Prospective observational study. SETTING Single tertiary care center. SUBJECTS Ninety-five patients presenting to an otolaryngology clinic. METHODS Participants completed questionnaires that included a history of medical and surgical therapies as well as sinusitis-specific quality-of-life measurements. Nasal mucus was collected in an outpatient clinic using an open cell foam technique. The nasal mucus glucose concentrations of patients with and without chronic rhinosinusitis were compared to the use of systemic and topical glucocorticoid treatment. RESULTS A statistically significant difference was measured between mean nasal glucose secretions of control patients, 10.2 mg/dL, compared with patients diagnosed with chronic rhinosinusitis, 18.4 mg/dL (P < .0001). Use of corticosteroids, both topical and systemic, did not correlate with nasal glucose concentrations. CONCLUSION Patients diagnosed with chronic rhinosinusitis have elevated nasal glucose concentrations compared with control patients, and this elevated nasal glucose level was independent of corticosteroid use. Nasal glucose may independently contribute to the pathophysiology of chronic rhinosinusitis.
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Affiliation(s)
- Kyle M Hatten
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Robert J Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Philadelphia Veterans Affairs Medical Center Surgical Services, Philadelphia, Pennsylvania, USA
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95
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Van Sambeek L, Cowley ES, Newman DK, Kato R. Sputum glucose and glycemic control in cystic fibrosis-related diabetes: a cross-sectional study. PLoS One 2015; 10:e0119938. [PMID: 25803537 PMCID: PMC4372582 DOI: 10.1371/journal.pone.0119938] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/31/2015] [Indexed: 12/04/2022] Open
Abstract
Cystic fibrosis-related diabetes affects up to half of cystic fibrosis patients and is associated with increased mortality and more frequent pulmonary exacerbations. However, it is unclear to what degree good glycemic control might mitigate these risks and clinical outcomes have not previously been studied in relation to glucose from the lower airways, the site of infection and CF disease progression. We initially hypothesized that diabetic cystic fibrosis patients with glycosylated hemoglobin (HbA1c) > 6.5% have worse pulmonary function, longer and more frequent exacerbations and also higher sputum glucose levels than patients with HbA1c ≤ 6.5% or cystic fibrosis patients without diabetes. To test this, we analyzed spontaneously expectorated sputum samples from 88 cystic fibrosis patients. The median sputum glucose concentration was 0.70 mM (mean, 4.75 mM; range, 0-64.6 mM). Sputum glucose was not correlated with age, sex, body mass index, diabetes diagnosis, glycemic control, exacerbation frequency or length, or pulmonary function. Surprisingly, sputum glucose was highest in subjects with normal glucose tolerance, suggesting the dynamics of glycemic control, sputum glucose and pulmonary infections are more complex than previously thought. Two-year mean HbA1c was positively correlated with the length of exacerbation admission (p < 0.01), and negatively correlated with measures of pulmonary function (p < 0.01). While total number of hospitalizations for exacerbations were not significantly different, subjects with an HbA1c > 6.5% were hospitalized on average 6 days longer than those with HbA1c ≤ 6.5% (p < 0.01). Current clinical care guidelines for cystic fibrosis-related diabetes target HbA1c ≤ 7% to limit long-term microvascular damage, but more stringent glycemic control (HbA1c ≤ 6.5%) may further reduce the short-term pulmonary complications.
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Affiliation(s)
- Lindsey Van Sambeek
- California Institute of Technology, Pasadena, California, United States of America
- Children’s Hospital Los Angeles, Pediatric Pulmonology, Los Angeles, California, United States of America
- * E-mail:
| | - Elise S. Cowley
- California Institute of Technology, Pasadena, California, United States of America
- Children’s Hospital Los Angeles, Pediatric Pulmonology, Los Angeles, California, United States of America
| | - Dianne K. Newman
- California Institute of Technology, Pasadena, California, United States of America
| | - Roberta Kato
- Children’s Hospital Los Angeles, Pediatric Pulmonology, Los Angeles, California, United States of America
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96
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Lewis C, Blackman SM, Nelson A, Oberdorfer E, Wells D, Dunitz J, Thomas W, Moran A. Diabetes-related mortality in adults with cystic fibrosis. Role of genotype and sex. Am J Respir Crit Care Med 2015; 191:194-200. [PMID: 25479583 DOI: 10.1164/rccm.201403-0576oc] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Diabetes is associated with increased mortality in cystic fibrosis. Aggressive screening and early institution of insulin treatment significantly reduced this risk over the period of 1992-2008. OBJECTIVES To determine if progressive improvement in cystic fibrosis-related diabetes (CFRD) mortality has continued since 2008, and examine associations with CFTR genotypes linked to pancreatic insufficiency and to sex. METHODS Chart review was performed on 664 patients followed from 2008 to 2012. MEASUREMENTS AND MAIN RESULTS Overall mortality for patients with CFRD was 1.8 per 100 person-years, compared with 0.5 in patients with CF without diabetes (P = 0.0002); neither rate changed significantly from mortality reported for 2003-2008. Genotype impacted both mortality and diabetes risk: adults with severe CFTR genotypes experienced greater mortality at every age older than 32 years than those with mild genotypes (P = 0.002), and the risk of developing CFRD was also greatly increased in those with severe genotypes (prevalence 60% in adult patients with severe vs. 14% in adults with mild mutations). CFRD had a direct influence on mortality because it was associated with increased risk of death within each genotype category (20 vs. 2%, P = 0.007 for mild; 12 vs. 4%, P = 0.012 for severe). There was also a sex difference in adults with severe CFTR genotypes; both mortality and CFRD prevalence were higher at every age in females than males. CONCLUSIONS Despite substantial improvement over time, mortality for CFRD patients greater than 30 years remains higher than for patients with CF without diabetes.
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Affiliation(s)
- Connor Lewis
- 1 Undergraduate Program in Biostatistics, University of Minnesota Morris, Morris, Minnesota
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97
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Yu H, Yang J, Xiao Q, Lü Y, Zhou X, Xia L, Nie D. Regulation of high glucose-mediated mucin expression by matrix metalloproteinase-9 in human airway epithelial cells. Exp Cell Res 2015; 333:127-35. [PMID: 25704757 DOI: 10.1016/j.yexcr.2015.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Abstract
Mucus hypersecretion is the key manifestation in patients with chronic inflammatory airway diseases and mucin 5AC (MUC5AC) is a major component of airway mucus. Matrix metalloproteinases (MMP)-9, have been found to be involved in the pathogenesis of inflammatory airway diseases. Hyperglycemia has been shown to be an independent risk factor for respiratory infections. We hypothesize that high glucose (HG)-regulates MMP-9 production and MMP-9 activity through nicotinamide adenine dinucleotide phosphate (NADPH)/reactive oxygen species (ROS) cascades pathways, leading to mucin production in human airway epithelial cells (16HBE). We show that HG increases MMP-9 production, MMP-9 activity and MUC5AC expression. These effects are prevented by small interfering RNA (siRNA) for MMP-9, indicating that HG-induced mucin production is MMP-9-dependent. HG activates MMP-9 production, MMP-9 activity and MUC5AC overproduction, which is inhibited by nPG, DMSO and DPI (inhibitors of ROS and NADPH), suggesting that HG-activated mucin synthesis is mediated by NADPH/ROS in 16HBE cells. These observations demonstrate an important role for MMP-9 activated by NADPH/ROS signaling pathways in regulating HG-induced MUC5AC expression. These findings may bring new insights into the molecular pathogenesis of the infections related to diabetes mellitus and lead to novel therapeutic intervention for mucin overproduction in chronic inflammatory airway diseases.
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Affiliation(s)
- Hongmei Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing 400016, China.
| | - Juan Yang
- Division of Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Xiao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xiangdong Zhou
- Division of Respiratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xia
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Daijing Nie
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing 400016, China
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98
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Gläser S, Krüger S, Merkel M, Bramlage P, Herth FJF. Chronic obstructive pulmonary disease and diabetes mellitus: a systematic review of the literature. Respiration 2015; 89:253-64. [PMID: 25677307 DOI: 10.1159/000369863] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
The objective of this systematic review was to discuss our current understanding of the complex relationship between chronic obstructive pulmonary disease (COPD) and type-2 diabetes mellitus (T2DM). We performed a systematic search of the literature related to both COPD and diabetes using PubMed. Relevant data connecting both diseases were compiled and discussed. Recent evidence suggests that diabetes can worsen the progression and prognosis of COPD; this may result from the direct effects of hyperglycemia on lung physiology, inflammation or susceptibility to bacterial infection. Conversely, it has also been suggested that COPD increases the risk of developing T2DM as a consequence of inflammatory processes and/or therapeutic side effects related to the use of high-dose corticosteroids. In conclusion, although there is evidence to support a connection between COPD and diabetes, additional research is needed to better understand these relationships and their possible implications.
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Affiliation(s)
- Sven Gläser
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases and Scientific Division of Pneumological Research and Pneumological Epidemiology, University of Greifswald, Greifswald, Germany
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99
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Hugo CJ, van der Merwe M. South African adolescents with cystic fibrosis: a qualitative exploration of their bio-psychosocial fields. J Child Adolesc Ment Health 2014; 26:177-91. [PMID: 25533405 DOI: 10.2989/17280583.2014.898643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This qualitative case study explored risk factors and protective factors in the bio-psychosocial fields of adolescents living with cystic fibrosis (CF). METHOD Semi-structured interviews were conducted with adolescents in the middle and late adolescent years (15-22 years) who had the defining characteristics of CF and were living in Gauteng province. FINDINGS Themes emerged from individual interviews. The fundamental human need to be understood and to understand was negatively affected as the illness affected socialisation and learning. Participants experienced an array of emotions including loss and bereavement linked to their illness and when friends with CF died. Constructive internal dialogue and positive thinking emerged as protective variables. Participants generally showed awareness of how they regulated their contact with the illness and how they self-regulate. Despite the severity of their symptoms and the taxing demands of managing CF, participants expressed hope for the future and could find some meaning in the illness. CONCLUSION Adolescents with CF who participated in this study indicated that they felt different from their peers. Apart from the general developmental tasks typical to adolescence they faced the challenge of managing a severe chronic and potentially terminal illness.
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Affiliation(s)
- Carina Jacobie Hugo
- a At the time of research - MA Psychology student, Centre for Child, Youth and Family Studies , Faculty of Health Sciences, North-West University , Potchefstroom
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100
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Garnett JP, Braun D, McCarthy AJ, Farrant MR, Baker EH, Lindsay JA, Baines DL. Fructose transport-deficient Staphylococcus aureus reveals important role of epithelial glucose transporters in limiting sugar-driven bacterial growth in airway surface liquid. Cell Mol Life Sci 2014; 71:4665-73. [PMID: 24810961 PMCID: PMC4232747 DOI: 10.1007/s00018-014-1635-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/11/2014] [Accepted: 04/28/2014] [Indexed: 02/05/2023]
Abstract
Hyperglycaemia as a result of diabetes mellitus or acute illness is associated with increased susceptibility to respiratory infection with Staphylococcus aureus. Hyperglycaemia increases the concentration of glucose in airway surface liquid (ASL) and promotes the growth of S. aureus in vitro and in vivo. Whether elevation of other sugars in the blood, such as fructose, also results in increased concentrations in ASL is unknown and whether sugars in ASL are directly utilised by S. aureus for growth has not been investigated. We obtained mutant S. aureus JE2 strains with transposon disrupted sugar transport genes. NE768(fruA) exhibited restricted growth in 10 mM fructose. In H441 airway epithelial-bacterial co-culture, elevation of basolateral sugar concentration (5-20 mM) increased the apical growth of JE2. However, sugar-induced growth of NE768(fruA) was significantly less when basolateral fructose rather than glucose was elevated. This is the first experimental evidence to show that S. aureus directly utilises sugars present in the ASL for growth. Interestingly, JE2 growth was promoted less by glucose than fructose. Net transepithelial flux of D-glucose was lower than D-fructose. However, uptake of D-glucose was higher than D-fructose across both apical and basolateral membranes consistent with the presence of GLUT1/10 in the airway epithelium. Therefore, we propose that the preferential uptake of glucose (compared to fructose) limits its accumulation in ASL. Pre-treatment with metformin increased transepithelial resistance and reduced the sugar-dependent growth of S. aureus. Thus, epithelial paracellular permeability and glucose transport mechanisms are vital to maintain low glucose concentration in ASL and limit bacterial nutrient sources as a defence against infection.
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Affiliation(s)
- James P. Garnett
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Daniela Braun
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Alex J. McCarthy
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Matthew R. Farrant
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Emma H. Baker
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Jodi A. Lindsay
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
| | - Deborah L. Baines
- Institute for Infection and Immunity, St George’s, University of London, Tooting, London, SW17 0RE UK
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