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Arslan M, Bahadir Z, Basiaga ML, Chalmers SJ, Demirel N. A pediatric cystic fibrosis arthropathy case who responded to Elexacaftor/Tezacaftor/Ivacaftor therapy. J Cyst Fibros 2023; 22:1120-1122. [PMID: 37709627 DOI: 10.1016/j.jcf.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Cystic fibrosis arthropathy (CFA) is a transient, intermittent form of arthritis that cannot be associated with any other disease other than CF thus making CFA a diagnosis of exclusion. NSAIDs, short-term intermittent splinting, glucocorticoids, and disease-modifying anti-rheumatic drugs are treatment options for CFA. Currently, there is no consensus on how to best treat CFA. Diagnosis and treatment of CFA remain a challenge for physicians and people with CF. The newest CFTR modulator therapy, elexacaftor/tezacaftor/ivacaftor (ETI), was approved by the FDA recently for children over the age of 6 with at least one Phe508del allele in the CFTR gene. Multiple clinical benefits of ETI in pulmonary functions and overall disease burden have been reported since its approval, however, the data on the musculoskeletal therapeutic benefits of ETI has been limited. In this report, we present a 7-year-old female with CF whose CFA symptoms resolved after starting ETI therapy.
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Affiliation(s)
| | - Zeynep Bahadir
- Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Matthew L Basiaga
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Rheumatology, Rochester, MN, United States of America
| | - Sarah J Chalmers
- Mayo Clinic, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN, United States of America
| | - Nadir Demirel
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology, Rochester, MN, United States of America
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2
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Holz F, Can E, Grehn C, Klotsche J, Materne B, Kruppa J, Kallinich T, Schwarz C. Manifestation and staging of arthropathy in cystic fibrosis. Defining different stages of cystic fibrosis arthropathy using ultrasound imaging and clinical scoring. J Cyst Fibros 2023; 22:980-988. [PMID: 37150649 DOI: 10.1016/j.jcf.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The true prevalence of cystic fibrosis arthropathy (CFA) remains unclear and may be significantly higher than previously reported. In recent studies, joint symptoms have been reported in up to 30% of adults with CF. This underlines the importance of CFA as a rising and clinically relevant co-morbidity. A clear definition of CFA is yet missing and its pathogenesis remains unclear. We investigated the clinical manifestation of CFA particularly via ultrasound (US) examination to define and implement a staging for clinical assessment. METHODS In a prospective cohort study between March 2018 and February 2020 a total of 98 consecutively recruited, adult cystic fibrosis (CF) patients underwent joint-US examination according to a newly developed ultrasound score (US-CFA). A clinical assessment including rheumatological scores (DAS28, HAQ) has been conducted as well as a specially designed questionnaire. Investigation on clinical and microbiological data, as well as a comprehensive laboratory analysis, were carried out. Cluster analysis has been performed to detect patterns defining different CFA stages based on disease activity. RESULTS US imaging has shown a considerable incidence of mild to moderate effusion as sign of joint inflammation/(teno-)synovitis. K-means clustering was used to distinguish 3 different stages of CFA based on the intensity of the detected effusion. These stages showed a significant association with disease activity (DAS28, p = 0.0004) as well as with patient-reported symptoms such as total weeks of CFA per year (p = 0.004), acute CFA (p = 0.015), chronic CFA (p = 0.016), disease burden (p = 0.04). Based on the US-CFA, 16% of patients suffered from severe CFA (II), 51% from intermediate CFA (I) and 33% did not present detectable arthritis. Positive serology for Chlamydophilia pneumoniae (IgA, IgG) and Chlamydia trachomatis (IgA, IgG) significantly correlated with the US-CFA. CONCLUSIONS The results of this study show that a definition and categorization for the clinical manifestation of CFA can be described through US examination, which is able to detect disease activity concordant with the DAS28 as a validated clinical score on arthritis. Defining these stages will lead to a better understanding of the clinical phenotype of the disease and will optimize diagnosis, therapy and research on CFA in the future.
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Affiliation(s)
- F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany.
| | - E Can
- Department of Radiology including Pediatric Radiology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany
| | - J Klotsche
- German Rheumatism Research Centre, Berlin, Germany
| | - B Materne
- Department of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - J Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Germany
| | - T Kallinich
- German Rheumatism Research Centre, Berlin, Germany; Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Rheumatology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Schwarz
- Division Cystic Fibrosis, CF Center Westbrandenburg, Clinic Westbrandenburg, Potsdam, Germany; HMU Health and Medical University, Potsdam, Germany
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3
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Mulrennan S, Sapru K, Tewkesbury D, Jones AM. Beyond the Lungs-Emerging Challenges in Adult Cystic Fibrosis Care. Semin Respir Crit Care Med 2023; 44:307-314. [PMID: 36535664 DOI: 10.1055/s-0042-1758734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cystic fibrosis (CF) is a multisystem disease. This article provides an up-to-date review of many of the nonrespiratory complications of CF, including mental health issues, nutritional and gastrointestinal problems, fertility issues, diabetes mellitus, bone health and musculoskeletal problems, liver disease, renal problems, and risk of malignancy. It highlights the recent impact of new therapies, including CF transmembrane conductance regulator modulators, on the nonrespiratory complications of CF and provides insights into the potential challenges faced by an aging population of adults with CF and their caregivers, including the potential future risk for cardiovascular disease.
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Affiliation(s)
- Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | - Karuna Sapru
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | - Daniel Tewkesbury
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester, United Kingdom
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Schmoll A, Launois C, Perotin JM, Ravoninjatovo B, Griffon M, Carré S, Mulette P, Ancel J, Hagenburg J, Lebargy F, Deslée G, Salmon JH, Dury S. Prevalence and Impact of Rheumatologic Pain in Cystic Fibrosis Adult Patients. Front Med (Lausanne) 2022; 8:804892. [PMID: 35211488 PMCID: PMC8861186 DOI: 10.3389/fmed.2021.804892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background With the improvement of cystic fibrosis (CF) patient survival, the prevalence of long-term complications increased, among them rheumatologic disorders. Methods The aim of this prospective study was to evaluate the prevalence of spinal and joint pain, and their impact on disability, anxiety, depression, and quality of life in CF adult patients. Results Forty-seven patients were analyzed, 72% of men, mean aged 28 years, with a mean body mass index of 22 kg/m2 and a mean FEV1% of 63%. Twenty-two patients (47%) described rheumatologic pain either spinal (n = 15, 32%) and/or joint pain (n = 14, 30%). Patients with spinal and/or joint pain were shorter (p = 0.023), more frequently colonized with Staphylococcus aureus (p < 0.008), had more frequent ΔF508 homozygous mutations (p = 0.014), and a trend for more impairment of the 6-min walking distance (p = 0.050). The presence of rheumatologic pain tended to be associated with disability according to the Health Assessment Questionnaire (HAQ) and anxiety. Compared with patients with no pain patients with both spinal and joint pain exhibited a more pronounced impact on the St George's Respiratory Questionnaire (SGRQ). Conclusion Rheumatologic pain is frequent in CF adult patients, and may affect daily living, anxiety and quality of life. Systematic assessment of rheumatologic pain should be included in the management of CF patients.
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Affiliation(s)
- Axelle Schmoll
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Bruno Ravoninjatovo
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Muriel Griffon
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Sophie Carré
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean Hagenburg
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Reims University Hospital, Reims, France.,EA3797, University of Reims Champagne-Ardenne, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
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5
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Grehn C, Dittrich AM, Wosniok J, Holz F, Hafkemeyer S, Naehrlich L, Schwarz C. Risk factors for cystic fibrosis arthropathy: Data from the German cystic fibrosis registry. J Cyst Fibros 2021; 20:e87-e92. [PMID: 34034985 DOI: 10.1016/j.jcf.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiology and potential risk factors for cystic fibrosis arthropathy (CFA) were studied in a relevant cystic fibrosis (CF) patient cohort. METHODS Cohort study of patients included in the German CF registry in 2016-2017. Descriptive analysis, exploratory tests and multivariable logistic regression were used to assess prevalence of CFA and associated potential risk factors for adult patients with/without chronic Pseudomonas aeruginosa infection. RESULTS 6069 CF patients aged from 0 to 78 years were analysed. CFA was observed in 4.9% of the patients. Prevalence was significantly higher in adult patients (8.4%) compared to patients <18 years (0.7%; p<0.0001). Logistic regression analyses in adult patients (n=3319) showed that CFA was significantly associated with increasing age (OR=1.04; 95% CI: 1.02-1.05; p<0.0001), female gender (OR=2.10; 95%CI:1.52-2.90; p<0.0001), number of hospitalizations (OR=1.24; 95%CI:1.12-1.36; p<0.0001), chronic P. aeruginosa infection (OR=1.83; 95%CI:1.28-2.61; p=0.0009), CF-related diabetes (OR=1.69; 95%CI:1.23-2.33; p=0.0013), pancreatic insufficiency (OR=2.39; 95%CI:1.28-4.46; p=0.0060) and sinusitis/polyps (OR=1.91; 95%CI:1.39-2.62; p<0.0001). In a subgroup analysis of adults without chronic P. aeruginosa infection (n=1550) CFA was also significantly associated with increasing age, female gender, increasing number of hospitalizations, pancreatic insufficiency as well as sinusitis/polyps; antimycotic treatment associated only in this subgroup while association with CF-related diabetes was not significant. CONCLUSION CFA is a frequent and clinically relevant co-morbidity particularly in adult CF patients. CFA is significantly more common in patients with chronic P. aeruginosa colonization but associations with other indicators for a more severe disease course were identified regardless of P. aeruginosa colonization status.
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Affiliation(s)
- Claudia Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany.
| | - A-M Dittrich
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - J Wosniok
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
| | - F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
| | - S Hafkemeyer
- Mukoviszidose Institut gGmbH (MI), Bonn, Germany
| | - L Naehrlich
- Department of Pediatrics, Justus-Liebig-University, Giessen, Germany
| | - C Schwarz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin, Berlin, Germany
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Orro A, Uggeri M, Rusnati M, Urbinati C, Pedemonte N, Pesce E, Moscatelli M, Padoan R, Cichero E, Fossa P, D'Ursi P. In silico drug repositioning on F508del-CFTR: A proof-of-concept study on the AIFA library. Eur J Med Chem 2021; 213:113186. [PMID: 33472120 DOI: 10.1016/j.ejmech.2021.113186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/14/2022]
Abstract
Computational drug repositioning is of growing interest to academia and industry, for its ability to rapidly screen a huge number of candidates in silico (exploiting comprehensive drug datasets) together with reduced development cost and time. The potential of drug repositioning has not been fully evaluated yet for cystic fibrosis (CF), a disease mainly caused by deletion of Phe 508 (F508del) of the cystic fibrosis transmembrane conductance regulator (CFTR) protein. F508del-CFTR is thus withheld in the endoplasmic reticulum and rapidly degraded by the ubiquitin/proteasome system. CF is still a fatal disease. Nowadays, it is treatable by some CFTR-rescuing drugs, but new-generation drugs with stronger therapeutic benefits and fewer side effects are still awaited. In this manuscript we report about the results of a pilot computational drug repositioning screening in search of F508del-CFTR-targeted drugs performed on AIFA library by means of a dedicated computational pipeline and surface plasmon resonance binding assay to experimentally validate the computational findings.
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Affiliation(s)
- Alessandro Orro
- Institute for Biomedical Technologies, National Research Council (ITB-CNR), Segrate, MI, Italy
| | - Matteo Uggeri
- Institute for Biomedical Technologies, National Research Council (ITB-CNR), Segrate, MI, Italy; Department of Pharmacy, Section of Medicinal Chemistry, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Marco Rusnati
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Chiara Urbinati
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Emanuela Pesce
- UOC Genetica Medica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marco Moscatelli
- Institute for Biomedical Technologies, National Research Council (ITB-CNR), Segrate, MI, Italy
| | - Rita Padoan
- Department of Pediatrics, Regional Support Centre for Cystic Fibrosis, Children's Hospital-ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Elena Cichero
- Department of Pharmacy, Section of Medicinal Chemistry, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Paola Fossa
- Department of Pharmacy, Section of Medicinal Chemistry, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Pasqualina D'Ursi
- Institute for Biomedical Technologies, National Research Council (ITB-CNR), Segrate, MI, Italy.
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Lara-Reyna S, Holbrook J, Jarosz-Griffiths HH, Peckham D, McDermott MF. Dysregulated signalling pathways in innate immune cells with cystic fibrosis mutations. Cell Mol Life Sci 2020; 77:4485-4503. [PMID: 32367193 PMCID: PMC7599191 DOI: 10.1007/s00018-020-03540-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Cystic fibrosis (CF) is one of the most common life-limiting recessive genetic disorders in Caucasians, caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). CF is a multi-organ disease that involves the lungs, pancreas, sweat glands, digestive and reproductive systems and several other tissues. This debilitating condition is associated with recurrent lower respiratory tract bacterial and viral infections, as well as inflammatory complications that may eventually lead to pulmonary failure. Immune cells play a crucial role in protecting the organs against opportunistic infections and also in the regulation of tissue homeostasis. Innate immune cells are generally affected by CFTR mutations in patients with CF, leading to dysregulation of several cellular signalling pathways that are in continuous use by these cells to elicit a proper immune response. There is substantial evidence to show that airway epithelial cells, neutrophils, monocytes and macrophages all contribute to the pathogenesis of CF, underlying the importance of the CFTR in innate immune responses. The goal of this review is to put into context the important role of the CFTR in different innate immune cells and how CFTR dysfunction contributes to the pathogenesis of CF, highlighting several signalling pathways that may be dysregulated in cells with CFTR mutations.
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Affiliation(s)
- Samuel Lara-Reyna
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS9 7TF, UK.
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK.
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, LS9 7TF, UK.
| | - Jonathan Holbrook
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS9 7TF, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, LS9 7TF, UK
| | - Heledd H Jarosz-Griffiths
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, LS9 7TF, UK
| | - Daniel Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, LS9 7TF, UK
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, LS9 7TF, UK
- Adult Cystic Fibrosis Unit, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Michael F McDermott
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS9 7TF, UK.
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, LS9 7TF, UK.
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8
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Lara-Reyna S, Scambler T, Holbrook J, Wong C, Jarosz-Griffiths HH, Martinon F, Savic S, Peckham D, McDermott MF. Metabolic Reprograming of Cystic Fibrosis Macrophages via the IRE1α Arm of the Unfolded Protein Response Results in Exacerbated Inflammation. Front Immunol 2019; 10:1789. [PMID: 31428093 PMCID: PMC6687873 DOI: 10.3389/fimmu.2019.01789] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022] Open
Abstract
Cystic Fibrosis (CF) is a recessive genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR mutations cause dysregulation of channel function with intracellular accumulation of misfolded proteins and endoplasmic reticulum (ER) stress, with activation of the IRE1α-XBP1 pathway that regulates a subset of unfolded protein response (UPR) genes. This pathway regulates a group of genes that control proinflammatory and metabolic responses in different immune cells; however, the metabolic state of immune cells and the role of this pathway in CF remain elusive. Our results indicate that only innate immune cells from CF patients present increased levels of ER stress, mainly affecting neutrophils, monocytes, and macrophages. An overactive IRE1α-XBP1 pathway reprograms CF M1 macrophages toward an increased metabolic state, with increased glycolytic rates and mitochondrial function, associated with exaggerated production of TNF and IL-6. This hyper-metabolic state, seen in CF macrophages, is reversed by inhibiting the RNase domain of IRE1α, thereby decreasing the increased glycolic rates, mitochondrial function and inflammation. Altogether, our results indicate that innate immune cells from CF patients are primarily affected by ER stress. Moreover, the IRE1α-XBP1 pathway of the UPR is responsible for the hyper-metabolic state seen in CF macrophages, which is associated with the exaggerated inflammatory response. Modulating ER stress, metabolism and inflammation, by targeting IRE1α, may improve the metabolic fitness of macrophages, and other immune cells in CF and other immune-related disorders.
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Affiliation(s)
- Samuel Lara-Reyna
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
| | - Thomas Scambler
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
| | - Jonathan Holbrook
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
| | - Chi Wong
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
| | - Heledd H Jarosz-Griffiths
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
| | - Fabio Martinon
- Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom.,Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom.,Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds, United Kingdom
| | - Daniel Peckham
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom.,Adult Cystic Fibrosis Unit, St. James's University Hospital, Leeds, United Kingdom
| | - Michael F McDermott
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Cystic Fibrosis Trust Strategic Research Centre, University of Leeds, Leeds, United Kingdom
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