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Concomitant Use of Elexacaftor/Tezacaftor/Ivacaftor and Etanercept in a Cystic Fibrosis Patient with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12051730. [PMID: 36902517 PMCID: PMC10003532 DOI: 10.3390/jcm12051730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
Patients with cystic fibrosis often complain of joint manifestations. However, only a few studies have reported the association between cystic fibrosis and juvenile idiopathic arthritis and addressed the therapeutic challenges of these patients. We describe the first paediatric case of a patient affected by cystic fibrosis, Basedow's disease and juvenile idiopathic arthritis who was contemporarily treated with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) and anti-tumor necrosis factor α (anti-TNFα). This report seems to reassure regarding the potential side effects of these associations. Moreover, our experience suggests that anti-TNFα is an effective option in CF patients affected by juvenile idiopathic arthritis, and is even safe for children receiving a triple CFTR modulator.
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Ramond E, Lepissier A, Ding X, Bouvier C, Tan X, Euphrasie D, Monbernard P, Dupuis M, Saubaméa B, Nemazanyy I, Nassif X, Ferroni A, Sermet-Gaudelus I, Charbit A, Coureuil M, Jamet A. Lung-adapted Staphylococcus aureus isolates with dysfunctional agr system trigger a proinflammatory response. J Infect Dis 2022; 226:1276-1285. [PMID: 35524969 DOI: 10.1093/infdis/jiac191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (Sa) dominates the lung microbiota of Cystic Fibrosis (CF) children and persistent clones are able to establish chronic infection for years, having a direct deleterious impact on lung function. However, in this context, the exact contribution of Sa to the decline in respiratory function in CF children is not elucidated. METHODS To investigate the contribution of persistent S. aureus clones in CF disease, we undertook the analysis of sequential isogenic isolates recovered from 15 young CF patients. RESULTS Using an Air-Liquid infection model, we observed a strong correlation between Sa adaption in the lung (late isolates), low toxicity and pro-inflammatory cytokine secretion. Conversely, early isolates appeared to be highly cytotoxic but did not promote cytokine secretion. We found that cytokine secretion was dependent on Staphylococcal protein A (Spa), which was selectively expressed in late compared to early isolates as a consequence of dysfunctional agr quorum-sensing system. Finally, we demonstrated the involvement of TNF-α receptor 1 signaling in the inflammatory response of airway epithelial cells to these lung-adapted Sa isolates. CONCLUSION Our results suggest an unexpected direct role of bacterial lung adaptation in the progression of chronic lung disease by promoting a pro-inflammatory response through acquired agr dysfunction.
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Affiliation(s)
- Elodie Ramond
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Agathe Lepissier
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Epithelial channellopathies, Cystic Fibrosis and other diseases, Paris, France
| | - Xiongqi Ding
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Clémence Bouvier
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Xin Tan
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Daniel Euphrasie
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Pierre Monbernard
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Marion Dupuis
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Bruno Saubaméa
- Cellular and Molecular Imaging facility, INSERM US25, UMS3612 CNRS, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - Ivan Nemazanyy
- Plateforme Etude du métabolisme, Structure Fédérative de Recherche Necker INSERM US24-CNRS UMS 3633, Paris, France
| | - Xavier Nassif
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Agnès Ferroni
- Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP Centre Université de Paris, Paris, France
| | - Isabelle Sermet-Gaudelus
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Epithelial channellopathies, Cystic Fibrosis and other diseases, Paris, France
| | - Alain Charbit
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Mathieu Coureuil
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France
| | - Anne Jamet
- Université de Paris; Faculté de Médecine, Paris, France.,INSERM U1151 - CNRS UMR 8253, Institut Necker-Enfants Malades. Team: Pathogenesis of Systemic Infections, Paris, France.,Department of Clinical Microbiology, Necker-Enfants Malades Hospital, AP-HP Centre Université de Paris, Paris, France
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Delaney-Nelson KL, Henry SM, Siva C. Rheumatoid arthritis in a patient with cystic fibrosis: challenging treatment options. BMJ Case Rep 2020; 13:13/9/e234305. [PMID: 32895251 DOI: 10.1136/bcr-2020-234305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 26-year-old Caucasian male patient with a history of cystic fibrosis presented with a 6-month history of diffuse joint pain and swelling. He was found to have active synovitis in bilateral wrists and proximal interphalangeal joints of the hands on physical examination. He was diagnosed with seropositive rheumatoid arthritis since he had positive anti-cyclic citrullinated peptide antibodies and erosions on hand and foot X-rays. The patient has responded well to abatacept which may have less infection risk compared with other biological therapies.
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Affiliation(s)
- Kelly Lynn Delaney-Nelson
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
| | - Sheena Marie Henry
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
| | - Chokkalingam Siva
- Department of Internal Medicine, Division of Rheumatology, University of Missouri Health System, Columbia, Missouri, USA
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Adelsten T, Rasmussen N, Katzenstein TL, Nielsen CT. Safe and effective tumour necrosis factor-α inhibitor (etanercept) treatment of chronic episodic arthritis in a patient with cystic fibrosis. Scand J Rheumatol 2016; 45:330-1. [DOI: 10.3109/03009742.2015.1122834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- T Adelsten
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - N Rasmussen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - TL Katzenstein
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - CT Nielsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rogers GB, van der Gast CJ, Serisier DJ. Predominant pathogen competition and core microbiota divergence in chronic airway infection. ISME JOURNAL 2014; 9:217-25. [PMID: 25036925 DOI: 10.1038/ismej.2014.124] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 01/11/2023]
Abstract
Chronic bacterial lung infections associated with non-cystic fibrosis bronchiectasis represent a substantial and growing health-care burden. Where Pseudomonas aeruginosa is the numerically dominant species within these infections, prognosis is significantly worse. However, in many individuals, Haemophilus influenzae predominates, a scenario associated with less severe disease. The mechanisms that determine which pathogen is most abundant are not known. We hypothesised that the distribution of H. influenzae and P. aeruginosa would be consistent with strong interspecific competition effects. Further, we hypothesised that where P. aeruginosa is predominant, it is associated with a distinct 'accessory microbiota' that reflects a significant interaction between this pathogen and the wider bacterial community. To test these hypotheses, we analysed 16S rRNA gene pyrosequencing data generated previously from 60 adult bronchiectasis patients, whose airway microbiota was dominated by either P. aeruginosa or H. influenzae. The relative abundances of the two dominant species in their respective groups were not significantly different, and when present in the opposite pathogen group the two species were found to be in very low abundance, if at all. These findings are consistent with strong competition effects, moving towards competitive exclusion. Ordination analysis indicated that the distribution of the core microbiota associated with each pathogen, readjusted after removal of the dominant species, was significantly divergent (analysis of similarity (ANOSIM), R=0.07, P=0.019). Taken together, these findings suggest that both interspecific competition and also direct and/or indirect interactions between the predominant species and the wider bacterial community may contribute to the predominance of P. aeruginosa in a subset of bronchiectasis lung infections.
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Affiliation(s)
- Geraint B Rogers
- 1] SAHMRI Infection and Immunity Theme, School of Medicine, Flinders University, Adelaide, South Australia, Australia [2] Immunity, Infection, and Inflammation Program, Mater Research Institute, University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | | | - David J Serisier
- 1] Immunity, Infection, and Inflammation Program, Mater Research Institute, University of Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia [2] Department of Respiratory Medicine, Mater Adult Hospital, South Brisbane, Queensland, Australia
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Disrupted tight junctions in the small intestine of cystic fibrosis mice. Cell Tissue Res 2013; 355:131-42. [PMID: 24169862 DOI: 10.1007/s00441-013-1734-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/19/2013] [Indexed: 02/06/2023]
Abstract
The tight junction (TJ) is the major determinant of paracellular permeability, which in the gut protects the body from entry of harmful substances such as microbial components. In cystic fibrosis (CF), there is increased permeability of the small intestine both in humans and in CF mice. To gain insight into the mechanisms of increased intestinal permeability in CF, I analyze the composition of the TJ in a cystic fibrosis transmembrane conductance regulator (Cftr) knockout mouse model. Significant changes in TJ gene expression in the CF intestine were found for Cldn1, Cldn7, Cldn8 and Pmp22, which were expressed at lower levels and Cldn2 that was expressed at a higher level. Protein levels of claudin-2 were increased in the CF intestine as compared to wild-type, while other TJ proteins were not significantly different. In the villus epithelium of the CF intestine, all TJ components analyzed were mislocalized to the basal cytoplasm and showed varying degrees of loss from the TJ and apico-lateral surfaces. The pore-forming claudin-2 in the CF intestine showed more intense staining but was correctly localized to the TJ, principally in the crypts that are enlarged in CF. The cytokine TNFα, known to affect TJ, was elevated to 160% of wild-type in the CF intestine. In summary, there is a dramatic redistribution of claudin proteins from the TJ/lateral membrane to the basal cytoplasm of the villus epithelium in the CF intestine. These changes in TJ protein localization in CF are likely to be involved in the increased permeability of the CF small intestine to macromolecules and TNFα may be a causative factor.
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