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Luzzatto L. A Journey from Blood Cells to Genes and Back. Annu Rev Genomics Hum Genet 2023; 24:1-33. [PMID: 37217201 DOI: 10.1146/annurev-genom-101022-105018] [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] [Indexed: 05/24/2023]
Abstract
I was attracted to hematology because by combining clinical findings with the use of a microscope and simple laboratory tests, one could often make a diagnosis. I was attracted to genetics when I learned about inherited blood disorders, at a time when we had only hints that somatic mutations were also important. It seemed clear that if we understood not only what genetic changes caused what diseases but also the mechanisms through which those genetic changes contribute to cause disease, we could improve management. Thus, I investigated many aspects of the glucose-6-phosphate dehydrogenase system, including cloning of the gene, and in the study of paroxysmal nocturnal hemoglobinuria (PNH), I found that it is a clonal disorder; subsequently, we were able to explain how a nonmalignant clone can expand, and I was involved in the first trial of PNH treatment by complement inhibition. I was fortunate to do clinical and research hematology in five countries; in all of them, I learned from mentors, from colleagues, and from patients.
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Affiliation(s)
- Lucio Luzzatto
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- University of Florence, Florence, Italy;
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Miller AC, Harris LM, Cavanaugh JE, Abou Alaiwa M, Stoltz DA, Hornick DB, Polgreen PM. The Rapid Reduction of Infection-Related Visits and Antibiotic Use Among People With Cystic Fibrosis After Starting Elexacaftor-Tezacaftor-Ivacaftor. Clin Infect Dis 2022; 75:1115-1122. [PMID: 35142340 PMCID: PMC9525072 DOI: 10.1093/cid/ciac117] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND People with cystic fibrosis (CF) routinely suffer from recurrent sinopulmonary infections. Such infections require frequent courses of antimicrobials and often involve multidrug-resistant organisms. The goal of this study was to identify real-world evidence for the effectiveness of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) in decreasing infection-related visits and antimicrobial use in people with CF. METHODS Using IBM MarketScan data, we identified 389 enrollees with CF who began taking ELX/TEZ/IVA before 1 December 2019 and were enrolled from 1 July 2019 to 14 March 2020. We also identified a comparison population who did not begin ELX/TEZ/IVA during the study period. We compared the following outcomes in the 15 weeks before and after medication initiation: total healthcare visits, inpatient visits, infection-related visits, and antimicrobial prescriptions. We analyzed outcomes using both a case-crossover analysis and a difference-in-differences analysis, to control for underlying trends. RESULTS For the case-crossover analysis, ELX/TEZ/IVA initiation was associated with the following changes over a 15-week period: change in overall healthcare visit dates, -2.5 (95% confidence interval, -3.31 to -1.7); change in inpatient admissions, -0.16 (-.22 to -.10); change in infection-related visit dates, -0.62 (-.93 to -.31); and change in antibiotic prescriptions, -0.78 (-1.03 to -.54). Results from the difference-in-differences approach were similar. CONCLUSIONS We show a rapid reduction in infection-related visits and antimicrobial use among people with CF after starting a therapy that was not explicitly designed to treat infections. Currently, there are >30 000 people living with CF in the United States alone. Given that this therapy is effective for approximately 90% of people with CF, the impact on respiratory infections and antimicrobial use may be substantial.
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Affiliation(s)
- Aaron C Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Logan M Harris
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | | | | - David A Stoltz
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Douglas B Hornick
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Abstract
BACKGROUND Male sex is associated with better lung function and survival in people with cystic fibrosis but it is unclear whether the survival benefit is solely due to the sex-effect on lung function. METHODS This study analyzes data between 1996 and 2015 from the longitudinal registry study of the UK Cystic Fibrosis Registry. We jointly analyze repeated measurements and time-to-event outcomes to assess how much of the sex effect on lung function also explains survival. These novel methods allow examination of association between percent of forced expiratory volume in 1 second (%FEV1) and covariates such as sex and genotype, and survival, in the same modeling framework. We estimate the probability of surviving one more year with a probit model. RESULTS The dataset includes 81,129 lung function measurements of %FEV1 on 9,741 patients seen between 1996 and 2015 and captures 1,543 deaths. Males compared with females experienced a more gradual decline in %FEV1 (difference 0.11 per year 95% confidence interval [CI] = 0.08, 0.14). After adjusting for confounders, both overall level of %FEV1 and %FEV1 rate of change are associated with the concurrent hazard for death. There was evidence of a male survival advantage (probit coefficient 0.15; 95% CI = 0.10, 0.19) which changed little after adjustment for %FEV1 using conventional approaches but was attenuated by 37% on adjustment for %FEV1 level and slope in the joint model (0.09; 95% CI = 0.06, 0.12). CONCLUSIONS We estimate that about 37% of the association of sex on survival in cystic fibrosis is mediated through lung function.
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Langawi MA, Byrnes C, Davies JC, Hamouda S, Kabra M, Rached SZ, Sands D, Shteinberg M, Taylor-Cousar J, Tullis E, Wainwright C. 'Go for it, dream big, work hard and persist': A message to the next generation of CF leaders in recognition of International Women's Day 2020. J Cyst Fibros 2020; 19:184-193. [PMID: 32156627 DOI: 10.1016/j.jcf.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
The focus for International Women's Day 2020 is gender equity:'We can actively choose to challenge stereotypes, fight bias, broaden perceptions, improve situations and celebrate women's achievements. Collectively, each one of us can help create a gender equal world.' We have come together as an international group of women holding senior positions within CF to raise awareness. There is growing recognition of gender imbalance within our sector in senior leadership, grant and publication success. Several institutions, such as National Institutes of Health, have missions to tackle this. The issues raised by our panellists were wide-ranging: decisions around starting a family, impact on career progression; experiences of bias in appointments or promotions; selfbelief. We hope that raising these issues will encourage future leaders in CF to step up, to build teams based on fairness, equity and diversity, and to catalyse steps towards this goal in their institutions and society more widely.
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Affiliation(s)
- Mona Al Langawi
- Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Cass Byrnes
- Starship Children's Health and Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Jane C Davies
- NHLI, Imperial College London and Royal Brompton Hospital, Cystic Fibrosis and Chronic Lung Disease Research Group, National Heart & Lung Institute, Imperial College London, Manresa Rd SW3 6LR, London, UK.
| | - Samia Hamouda
- Pediatrics Department B, Bechir Hamza Children's Hospital of Tunis, Tunisia
| | - Madhulika Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samia Z Rached
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Universidade de São Paulo, SP, Brazil
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Michal Shteinberg
- Pulmonary Division, Lady Davis-Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Elizabeth Tullis
- Internal Medicine, Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Claire Wainwright
- Respiratory and Sleep Medicine, Queensland Children's Hospital and Faculty of Medicine, University of Queensland, Brisbane, Australia
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Tournier A, Murris M, Prevotat A, Fanton A, Bettiol C, Parinaud J. Fertility of women with cystic fibrosis: a French survey. Reprod Biomed Online 2019; 39:492-495. [PMID: 31256948 DOI: 10.1016/j.rbmo.2019.04.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Although the impact of cystic fibrosis on male fertility is well known, very few studies have investigated its effect on female fertility. This study aimed to evaluate the fertility status of women with cystic fibrosis. DESIGN A questionnaire was sent to 220 women with cystic fibrosis. The questions concerned their desire to become a parent, achievement or not of a pregnancy, the time to become pregnant, the means of achieving pregnancy (spontaneously or with medical assistance) and the outcome of the pregnancy. Ninety-eight patients responded to the questionnaire. RESULTS Of the 46 women who sought pregnancy, 25 (54%) had at least one live birth without treatment, while 11 (24%) required infertility treatment to obtain a live birth and 10 (22%) had no delivery. The mean time-to-pregnancy was 12 months (1-180). The reasons for preferring not to become pregnant were mainly fear of the interaction between cystic fibrosis and pregnancy and of the transmission of cystic fibrosis to children. CONCLUSIONS Fertility seems to be slightly impaired in women with cystic fibrosis, because 37% of them failed to become pregnant without medical assistance. Because the outcome of pregnancies appears normal, patients should be informed about the possibility of becoming mothers and be made aware of the risk of unwanted pregnancies.
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Affiliation(s)
- Anna Tournier
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | - Marlène Murris
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Toulouse University Hospital, France
| | - Anne Prevotat
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Lille University Hospital, France
| | - Annlyse Fanton
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Dijon University Hospital, France
| | - Célia Bettiol
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | - Jean Parinaud
- Department of Reproductive Medicine, Toulouse University Hospital, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, Toulouse, France.
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Taylor-Robinson D, Archangelidi O, Carr SB, Cosgriff R, Gunn E, Keogh RH, MacDougall A, Newsome S, Schlüter DK, Stanojevic S, Bilton D. Data Resource Profile: The UK Cystic Fibrosis Registry. Int J Epidemiol 2019; 47:9-10e. [PMID: 29040601 PMCID: PMC5837577 DOI: 10.1093/ije/dyx196] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Olia Archangelidi
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London
| | | | | | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy MacDougall
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Simon Newsome
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniela K Schlüter
- Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster University, Lancaster, UK
| | - Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diana Bilton
- National Heart and Lung Institute, Imperial College London, London, UK
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Nightingale JA, Osmond C. Does current reporting of lung function by the UK cystic fibrosis registry allow a fair comparison of adult centres? J Cyst Fibros 2017; 16:585-591. [PMID: 28462874 DOI: 10.1016/j.jcf.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome data for UK cystic fibrosis centres are publicly available in an annual report, which ranks centres by median FEV1% predicted. We wished to assess whether there are differences in lung function outcomes between adult centres that might imply differing standards of care. METHODS UK Registry data from 4761 subjects at 34 anonymised adult centres were used to calculate mean FEV1% and rate of change of lung function for 2007-13. These measures were used to rank centres and compare outcomes. RESULTS There are minor differences between centres for mean FEV1% for some years of the study and for rate of change of lung function over the study period. However, rankings are critically dependent on the outcome measure chosen and centre variation becomes negligible once patient population characteristics are taken into account. CONCLUSIONS We have demonstrated that the ranking of centres is biased and any apparent difference in respiratory outcomes is unlikely to be related to differing standards of care between centres.
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Affiliation(s)
- Julia Anne Nightingale
- Department of Adult Cystic Fibrosis, University Hospital Southampton NHS Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, United Kingdom.
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Salvatore D, Buzzetti R, Mastella G. Update of literature from cystic fibrosis registries 2012-2015. Part 6: Epidemiology, nutrition and complications. Pediatr Pulmonol 2017; 52:390-398. [PMID: 27685428 DOI: 10.1002/ppul.23611] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/04/2016] [Accepted: 09/19/2016] [Indexed: 12/28/2022]
Abstract
Patient registries provide useful information to afford more knowledge on rare diseases like Cystic Fibrosis (CF). Twenty-two studies originating from national CF registries, focusing on demographics, survival, genetics, nutritional status, and non-pulmonary complications, were published between December 2011 and March 2015. The purpose of this review article is to examine these reports, aiming attention to the clinical characteristics of CF patients included in the registries, current, and estimated future epidemiological data, the role of gender gap, the increasing survival in different countries. Some studies offer insights into pubertal growth and non-pulmonary complications, such as liver disease, nephropathy, and cancer. Pediatr Pulmonol. 2017;52:390-398. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Donatello Salvatore
- Cystic Fibrosis Center, AOR Hospital San Carlo, Via Potito Petrone, Potenza, 85100, Italy
| | - Roberto Buzzetti
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
| | - Gianni Mastella
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
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Frischer T, Eber E, Ellemunter H, Zacharasiewicz A, Kaluza I, Riedler J, Renner S. Cystic fibrosis in Austria. Wien Klin Wochenschr 2017; 129:527-532. [PMID: 28236043 DOI: 10.1007/s00508-017-1179-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Registry data for patients with cystic fibrosis (CF) are increasingly used to evaluate the natural history, for benchmarking of therapy and in order to identify eligible patients for clinical studies. So far, no data on frequency and clinical status of CF patients have been available for Austria on a national level. We collected data of CF patients treated 2014 in Austrian CF outpatient clinics by means of a European CF registry and on an individual search basis. A total of 773 CF patients with a median age of 18.9 years (SD 11.8 years) were seen in 13 centers (18-151 patients/center). Homozygous F508del mutation being the most common genotype was observed in 48.8% of patients. Mean age at diagnosis was 27 days. In 59% of all patients FEV1% predicted (Forced Exspiratory Volume in 1 second) was <80% and in 20% <50%. An average FEV1 predicted decline per year of 1.9% was observed between 6-18 years of age. Colonisation with Pseudomonas aeruginosa ranged between 12% and 69% in adult patients and in 0-16% in children with CF. Burkholderia cepacia complex species were present in a total of 29 samples (3.8%). Insulin therapy for diabetes was given in 14.5%. Liver involvement was reported in 36.3%. A wide variation of prescribed CF therapy was observed between centers. Data on CF patients living in Austria are now available and form a basis for clinical benchmarking as well as analyses from a public health perspective.
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Affiliation(s)
- Thomas Frischer
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria.
| | - Ernst Eber
- Department of Pneumology and Allergology, University Children's Hospital of Graz, Graz, Austria
| | - Helmut Ellemunter
- Department of Pediatrics and Adolescent medicine, University Children's Hospital of Innsbruck, Innsbruck, Austria
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Ingrid Kaluza
- Department of Pneumology, Krankenhaus Hietzing, Vienna, Austria
| | - Josef Riedler
- Department of Pediatrics and Adolescent Medicine, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Austria
| | - Sabine Renner
- Department of Pneumology, Allergology and Endocrinology, University Children's Hospital of Vienna, Vienna, Austria
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Buttini F, Rossi I, Di Cuia M, Rossi A, Colombo G, Elviri L, Sonvico F, Balducci AG. Combinations of colistin solutions and nebulisers for lung infection management in cystic fibrosis patients. Int J Pharm 2016; 502:242-8. [PMID: 26854429 DOI: 10.1016/j.ijpharm.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
In this work different nebulisers were investigated in order to assess their efficiency in combination with colistimethate sodium (CMS) inhalation products. Four nebulisers, namely I-neb(®), Aeroneb(®) Go, eFlow(®)rapid and PARI LC(®) Sprint were studied in terms of delivered dose (DD), drug delivery rate (DDR) and respirable dose (RD) of CMS. The goal was to provide scientific data to physicians for prescribing the most appropriate nebuliser for the CMS specific user. All the apparatuses nebulised ColiFin 1MIU/3 ml solution (80 mg of CMS) with delivered doses between 31% and 41% of the loaded amount. Aeroneb Go showed the longest nebulisation time (more than 20 min). When ColiFin 2 MIU/4 ml was nebulised with eFlow rapid or PARI LC Sprint, the CMS respirable dose was 45.3mg and 39.2mg, in times of 5.6 and 10.8 min, respectively. I-neb, having a medication cup capacity limited to 0.4 ml, loaded with Promixin 0.4 MIU/0.4 ml (32 mg of CMS), provided in a time of 9 min a RD of 21.5mg, a value slightly higher than those obtained by nebulising ColiFin 1 MIU/3 ml with the other nebulisers (range 15.9-17.6 mg). The results illustrate that the clinical outcome depends on the comparative analysis of nebulisation efficiency (respirable dose) and convenience (time), not disregarding the ratios between the amount loaded, delivered and deposited at lung level.
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Affiliation(s)
- Francesca Buttini
- Department of Pharmacy, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy; Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, SE19NH London, United Kingdom.
| | - Irene Rossi
- Department of Pharmacy, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
| | - Marica Di Cuia
- Interdepartmental Centre, Biopharmanet-TEC, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
| | - Alessandra Rossi
- Department of Pharmacy, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
| | - Gaia Colombo
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Fossato di Mortara 17/19, 44121 Ferrara, Italy
| | - Lisa Elviri
- Department of Pharmacy, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
| | - Fabio Sonvico
- Department of Pharmacy, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
| | - Anna Giulia Balducci
- Interdepartmental Centre, Biopharmanet-TEC, University of Parma, Viale delle Scienze 27/A, 43124 Parma, Italy
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Salvatore D, Buzzetti R, Mastella G. An overview of international literature from cystic fibrosis registries. Part 5: Update 2012-2015 on lung disease. Pediatr Pulmonol 2016; 51:1251-1263. [PMID: 27163867 DOI: 10.1002/ppul.23473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 01/01/2023]
Abstract
Patient registry data is a tool for defining the clinical course and risk factors in patients with less common diseases like Cystic Fibrosis. Forty-one registry-based reports on lung disease in Cystic Fibrosis were published between 2011 and 2015. The aim of this review is to describe and discuss the results of these reports, focusing on the risk factors for lung disease progression, specific microbiologic pathogens (e.g., non-tuberculous mycobacteria), disease complications, comparisons between registries of different countries, the impact of socio-economic status, and evaluation of benefits and costs of therapies. Techniques for improved clinical trial design were also studied. Pediatr Pulmonol. 2016;51:1251-1263. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Roberto Buzzetti
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
| | - Gianni Mastella
- Italian Cystic Fibrosis Research Foundation, Ospedale Maggiore, Verona, Italy
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12
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Gensburger D, Boutroy S, Chapurlat R, Nove-Josserand R, Roche S, Rabilloud M, Durieu I. Reduced bone volumetric density and weak correlation between infection and bone markers in cystic fibrosis adult patients. Osteoporos Int 2016; 27:2803-2813. [PMID: 27165286 DOI: 10.1007/s00198-016-3612-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/20/2016] [Indexed: 02/05/2023]
Abstract
UNLABELLED In our current adult CF population, low BMD prevalence was only 20 %, lower than that historically described. We found a mild increase of serum RANK-L levels, independent from the bone resorption level. The increased fracture risk in CF may be explained by a lower tibial cortical thickness and total vBMD. INTRODUCTION Bone disease is now well described in cystic fibrosis (CF) adult patients. CF bone disease is multifactorial but many studies suggested the crucial role of inflammation. The objectives of this study were, in a current adult CF population, to assess the prevalence of bone disease, to examine its relationship with infections and inflammation, and to characterize the bone microarchitecture using high resolution peripheral scanner (HR-pQCT). METHODS Fifty-six patients (52 % men, 26 ± 7 years) were assessed in clinically stable period, during a respiratory infection, and finally 14 days after the end of antibiotic therapy. At each time points, we performed a clinical evaluation, lung function tests, and biochemical tests. Absorptiometry and dorso-lumbar radiographs were also performed. A subgroup of 40 CF patients (63 % men, 29 ± 6 years) underwent bone microarchitecture assessment and was age- and gender-matched with 80 healthy controls. RESULTS Among the 56 CF patients, the prevalence of low areal BMD (T-score < -2 at any site), was 20 % (95 % CI: [10.2 %; 32.4 %]). After infections, serum RANK-L (+24 %, p = 0.08) and OPG (+13 %, p = 0.04) were increased with a stable ratio. Microarchitectural differences were mostly observed at the distal tibia, with lower total and cortical vBMD and trabecular thickness (respectively -9.9, -3.0, and -5 %, p < 0.05) in CF patients compared to controls, after adjustment for age, gender, weight, and height. CONCLUSIONS In this study, bone disease among adult CF patients was less severe than that previously described with only 20 % of CF patients with low BMD. We found a mild increase of biological marker levels and an impaired volumetric density of the tibia that may explain the increased fracture risk in CF population.
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Affiliation(s)
- D Gensburger
- INSERM UMR 1033, Université de Lyon, Lyon, France.
- Department of Rheumatology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France.
| | - S Boutroy
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Department of Rheumatology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - R Nove-Josserand
- Cystic Fibrosis Adult Reference Centre, Department of Internal Medicine, Université de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - S Roche
- Department of Biostatistique, Hospices Civils de Lyon; Université de Lyon. Université Lyon 1, CNRS UMR558, Laboratoire de Biométrie et Biologie évolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - M Rabilloud
- Department of Biostatistique, Hospices Civils de Lyon; Université de Lyon. Université Lyon 1, CNRS UMR558, Laboratoire de Biométrie et Biologie évolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - I Durieu
- Cystic Fibrosis Adult Reference Centre, Department of Internal Medicine, Université de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Abstract
Cystic fibrosis (CF) is the most common autosomal-recessive disease in white persons. Significant advances in therapies and outcomes have occurred for people with CF over the past 30 years. Many of these improvements have come about through the concerted efforts of the CF Foundation and international CF societies; networks of CF care centers; and the worldwide community of care providers, researchers, and patients and families. There are still hurdles to overcome to continue to improve the quality of life, reduce CF complications, prolong survival, and ultimately cure CF. This article reviews the epidemiology of CF, including trends in incidence and prevalence, clinical characteristics, common complications, and survival.
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Affiliation(s)
- Don B. Sanders
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Aliza Fink
- Epidemiology, Cystic Fibrosis Foundation, Bethesda, Maryland
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14
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Shen Y, Liu J, Zhong L, Mogayzel PJ, Zeitlin PL, Sosnay PR, Zhao S. Clinical Phenotypes and Genotypic Spectrum of Cystic Fibrosis in Chinese Children. J Pediatr 2016; 171:269-76.e1. [PMID: 26826884 DOI: 10.1016/j.jpeds.2015.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To characterize the clinical phenotypes and genotypic spectrum of cystic fibrosis (CF) in Chinese children. STUDY DESIGN We recruited and characterized the phenotypes of 21 Chinese children with CF. All 27 exons and their flanking sequences of the CF transmembrane conductance regulator gene were amplified and sequenced to define the genotypes. RESULTS Bronchiectasis (95.2%) and sinusitis (76.2%) were the most common clinical presentations among our patients. By contrast, pancreatic insufficiency was rare (14.3%). The predominant organism found in the airways was Pseudomonas aeruginosa (66.7%). There were obvious reductions of forced expiratory volume in the first second (mean ± SD: 71.8% ± 17.2% predicted) and forced expiratory flows at 75% of exhaled vital capacity (33.7% ± 20.4% predicted) in children with CF. Overall, we identified 22 different mutations, including 12 missense, 5 nonsense, 2 frameshift, 1 in-frame insertion, 1 splice site, and 1 3'untranslated region mutation. Of these, 7 were novel observations (W216X[780G→A], 1092insA, Q359X, D567Y, 2623-126T→C, 3439delA and 4575+110C→G), and the most common types were L88X and I556V. One de novo mutation (1092insA) was also revealed. Except for N1303K and R334W, none of them were present in the common Caucasian CF transmembrane conductance regulator mutation-screening panels. CONCLUSIONS There was a 5.7-year delay between the first clinical presentation and the eventual CF diagnosis, suggesting that CF may be underdiagnosed in China. The clinical phenotypes and genotypic spectrum are different from that observed in Caucasians.
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Affiliation(s)
- Yuelin Shen
- Department No. 2 of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jinrong Liu
- Department No. 2 of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Lili Zhong
- Pediatric Institute, Hunan Provincial People's Hospital, Changsha, China
| | - Peter J Mogayzel
- Department of Pediatrics, Cystic Fibrosis Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pamela L Zeitlin
- Department of Pediatrics, Cystic Fibrosis Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patrick R Sosnay
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD
| | - Shunying Zhao
- Department No. 2 of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China.
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15
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Quintana-Gallego E, Ruiz-Ramos M, Delgado-Pecellin I, Calero C, Soriano JB, Lopez-Campos JL. Mortality from cystic fibrosis in Europe: 1994-2010. Pediatr Pulmonol 2016; 51:133-42. [PMID: 26584153 DOI: 10.1002/ppul.23337] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To date, available mortality trends due to cystic fibrosis (CF) have been limited to the analysis of certain countries in different parts of the world showing that mortality trends have been constantly decreasing. However, no studies have examined Europe as a whole. The present study aims to analyze CF mortality trends by gender within the European Union (EU) and to quantify potential years of life lost (PYLL). DESIGN Deaths from the 27 EU countries were obtained from the statistical office of the EU from the years 1994-2010. Crude and age-standardized mortality rates (ASR) were estimated for women and men using the standard European population, expressed in deaths per 1,000,000 persons. The PYLL from ages 0 up to 30 years were estimated. Trends were studied by a joinpoint regression analysis. RESULTS During the study period, 5,130 deaths (2,443 in males and 2,687 in females) were identified. Females had a slightly higher mortality rate than males, with a downward trend observed for both genders. In males, the ASR changed from 1.34 in 1994 to 1.03 in 2010. In females, the ASR changed from 1.42 in 1994 to 0.92 in 2010. The mean age at death and PYLL increased for both genders. The joinpoint analysis did not identify any significant joinpoint for either gender for ASR or PYLL. CONCLUSIONS Our data suggest a continued downward trend of CF mortality throughout the EU, with differences by country and gender.
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Affiliation(s)
- Esther Quintana-Gallego
- Unidad de Fibrosis Quística, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ruiz-Ramos
- Consejería de Igualdad, Salud y Políticas Sociales de Andalucía, Seville, Spain
| | - Isabel Delgado-Pecellin
- Unidad de Fibrosis Quística, Servicio de Pediatría, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Carmen Calero
- Unidad de Fibrosis Quística, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain
| | - Jose Luis Lopez-Campos
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain
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16
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Smith DJ, Ramsay KA, Yerkovich ST, Reid DW, Wainwright CE, Grimwood K, Bell SC, Kidd TJ. Pseudomonas aeruginosa antibiotic resistance in Australian cystic fibrosis centres. Respirology 2015; 21:329-37. [PMID: 26711802 DOI: 10.1111/resp.12714] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/20/2015] [Accepted: 08/29/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE In cystic fibrosis (CF), chronic Pseudomonas aeruginosa infection is associated with increased morbidity, antibiotic treatments and mortality. By linking Australian CF registry data with a national microbiological data set, we examined the association between where treatment was delivered, its intensity and P. aeruginosa antibiotic resistance. METHODS Sputa were collected from paediatric and adult CF patients attending 18 Australian CF centres. P. aeruginosa antibiotic susceptibilities determined by local laboratories were correlated with clinical characteristics, treatment intensity and infection with strains commonly shared among Australian CF patients. Between-centre differences in treatment and antibiotic resistance were also compared. RESULTS Large variations in antibiotic usage, maintenance treatment practices and multi-antibiotic resistant P. aeruginosa (MARPA) prevalence exist between Australian CF centres, although the overall proportions of MARPA isolates were similar in paediatric and adult centres (31% vs 35%, P = 0.29). Among paediatric centres, MARPA correlated with intravenous antibiotic usage and the Australian state where treatment was delivered, while azithromycin, reduced lung function and treating state predicted intravenous antibiotic usage. In adult centres, body mass index (BMI) and treating state were associated with MARPA, while intravenous antibiotic use was predicted by gender, BMI, dornase-alpha, azithromycin, lung function and treating state. In adults, P. aeruginosa strains AUST-01 and AUST-02 independently predicted intravenous antibiotic usage. CONCLUSION Increased treatment intensity in paediatric centres and the Australian state where treatment was received are both associated with greater risk of MARPA, but not worse clinical outcomes.
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Affiliation(s)
- Daniel J Smith
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kay A Ramsay
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - David W Reid
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Scott C Bell
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Timothy J Kidd
- The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Centre for Infection & Immunity, Queen's University Belfast, Belfast, Northern Ireland, UK
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Oglesby IK, Agrawal R, Mall MA, McElvaney NG, Greene CM. miRNA-221 is elevated in cystic fibrosis airway epithelial cells and regulates expression of ATF6. Mol Cell Pediatr 2015; 2:1. [PMID: 26542291 PMCID: PMC5407678 DOI: 10.1186/s40348-014-0012-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 11/28/2014] [Indexed: 12/20/2022] Open
Abstract
Background MicroRNA (miRNA) and messenger RNA (mRNA) expression differs in
cystic fibrosis (CF) versus non-CF bronchial epithelium. Here, the role of miRNA
in basal regulation of the transcription factor ATF6 was investigated in bronchial
epithelial cells in vitro and in vivo. Methods Using in silico analysis, miRNAs
predicted to target the 3′untranslated region (3′UTR) of the human ATF6 mRNA were
identified. Results Three of these miRNAs, miR-145, miR-221 and miR-494, were upregulated in
F508del-CFTR homozygous CFBE41o- versus non-CF 16HBE14o- bronchial epithelial
cells and also in F508del-CFTR homozygous or heterozygous CF (n = 8) versus non-CF (n = 9) bronchial brushings. ATF6 was experimentally validated as a
molecular target of these miRNAs through the use of a luciferase reporter vector
containing the full-length 3′UTR of ATF6. Expression of ATF6 was observed to be
decreased in CF both in vivo and in vitro. miR-221 was also predicted to regulate murine
ATF6, and its expression was significantly increased in native airway tissues of
6-week-old βENaC-overexpressing transgenic mice with CF-like lung disease versus
wild-type littermates. Conclusions These results implicate miR-145, miR-221 and miR-494 in the
regulation of ATF6 in CF bronchial epithelium, with miR-221 demonstrating
structural and functional conservation between humans and mice. The altered miRNA
expression evident in CF bronchial epithelial cells can affect expression of
transcriptional regulators such as ATF6.
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Affiliation(s)
- Irene K Oglesby
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, 9, Ireland.
| | - Raman Agrawal
- Department of Translational Pulmonology, Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, 69120, Heidelberg, Germany.
| | - Marcus A Mall
- Department of Translational Pulmonology, Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, 69120, Heidelberg, Germany. .,Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, 69120, Heidelberg, Germany.
| | - Noel G McElvaney
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, 9, Ireland.
| | - Catherine M Greene
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, 9, Ireland.
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18
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Hortencio TDR, Nogueira RJN, Marson FADL, Hessel G, Ribeiro JD, Ribeiro AF. [Factors impacting the growth and nutritional status of cystic fibrosis patients younger than 10 years of age who did not undergo neonatal screening]. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2015; 33:3-11. [PMID: 25681074 PMCID: PMC4436950 DOI: 10.1016/j.rpped.2014.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/30/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate by clinical and laboratory parameters how cystic fibrosis (CF) affects growth and nutritional status of children who were undergoing CF treatment but did not receive newborn screening. METHODS A historical cohort study of 52 CF patients younger than 10 years of age were followed in a reference center in Campinas, Southeast Brazil. Anthropometric measurements were abstracted from medical records until March/2010, when neonatal screening program was implemented. Between September/2009 and March/2010, parental height of the 52 CF patients were also measured. RESULTS Regarding nutritional status, four patients had Z-scores ≤ -2 for height/age (H/A) and body mass index/age (BMI/A). The following variables were associated with improved H/A ratio: fewer hospitalizations, longer time from first appointment to diagnosis, longer time from birth to diagnosis and later onset of respiratory disease. Forced vital capacity [FVC(%)], forced expiratory flow between 25-75% of FVC [FEF25-75(%)], forced expiratory volume in the first second [FEV1(%)], gestational age, birth weight and early respiratory symptoms were associated with IMC/A. CONCLUSIONS Greater number of hospitalizations, diagnosis delay and early onset of respiratory disease had a negative impact on growth. Lower spirometric values, lower gestational age, lower birth weight, and early onset of respiratory symptoms had negative impact on nutritional status. Malnutrition was observed in 7.7% of cases, but 23% of children had nutritional risk.
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Affiliation(s)
| | | | | | - Gabriel Hessel
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
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19
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Nasal endoscopy and paranasal sinus computerised tomography (CT) findings in an Irish cystic fibrosis adult patient group. Eur Arch Otorhinolaryngol 2014; 272:3353-9. [DOI: 10.1007/s00405-014-3446-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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20
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Nony P, Kurbatova P, Bajard A, Malik S, Castellan C, Chabaud S, Volpert V, Eymard N, Kassai B, Cornu C. A methodological framework for drug development in rare diseases. Orphanet J Rare Dis 2014; 9:164. [PMID: 25774598 PMCID: PMC4255937 DOI: 10.1186/s13023-014-0164-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/14/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Developing orphan drugs is challenging because of their severity and the requisite for effective drugs. The small number of patients does not allow conducting adequately powered randomized controlled trials (RCTs). There is a need to develop high quality, ethically investigated, and appropriately authorized medicines, without subjecting patients to unnecessary trials. AIMS AND OBJECTIVES The main aim is to develop generalizable framework for choosing the best-performing drug/endpoint/design combinations in orphan drug development using an in silico modeling and trial simulation approach. The two main objectives were (i) to provide a global strategy for each disease to identify the most relevant drugs to be evaluated in specific patients during phase III RCTs, (ii) and select the best design for each drug to be used in future RCTs. METHODOLOGICAL APPROACH In silico phase III RCT simulation will be used to find the optimal trial design and was carried out in two steps: (i) statistical analysis of available clinical databases and (ii) integrative modeling that combines mathematical models for diseases with pharmacokinetic-pharmacodynamics models for the selected drug candidates. CONCLUSION There is a need to speed up the process of orphan drug development, develop new methods for translational research and personalized medicine, and contribute to European Medicines Agency guidelines. The approach presented here offers many perspectives in clinical trial conception.
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21
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Early colon screening of adult patients with cystic fibrosis reveals high incidence of adenomatous colon polyps. J Clin Gastroenterol 2014; 48:e85-8. [PMID: 24275715 DOI: 10.1097/mcg.0000000000000034] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND GOALS Cystic fibrosis (CF) is associated with increased incidence of gastrointestinal cancer. Increasing overall life expectancy of CF patients predicts emergence of colon cancer as a significant clinical problem in the adult CF population. The primary aim of this study was to estimate the incidence of adenomatous colon polyps in patients with CF during systematic screening by colonoscopy. STUDY This is a single-center series of 45 CF patients aged 40 years and above (mean age, 47 y) undergoing colonoscopic screening. A fraction of these patients (9/45) had history of organ transplantation. Results from transplant and nontransplant patients were analyzed separately. RESULTS Adult CF patients have a high incidence of adenomatous polyps identified by colonoscopy. In addition, positive examinations are characterized by multiple polyps and common features of advanced pathology. The incidence of adenomatous colon polyps is greater in male patients, although the 1 patient in this cohort found to have colorectal cancer was female. CONCLUSIONS CF has features of a hereditary colon cancer syndrome. Increasing life expectancy of CF patients suggests that earlier colon screening in this population may be warranted. Optimal criteria for initiation of screening and frequency of surveillance should be subject of further studies.
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22
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Adaptive approaches to licensing, health technology assessment, and introduction of drugs and devices. Int J Technol Assess Health Care 2014; 30:241-9. [PMID: 24921416 DOI: 10.1017/s0266462314000191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adaptive approaches to the introduction of drugs and medical devices involve the use of an evolving evidence base rather than conventional single-point-in-time evaluations as a proposed means to promote patient access to innovation, reduce clinical uncertainty, ensure effectiveness, and improve the health technology development process. METHODS This report summarizes a Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations from invited experts, discussions among attendees about real-world case examples, and background paper. RESULTS For adaptive approaches to be understood, accepted, and implemented, the Forum identified several key issues that must be addressed. These include the need to define the goals of and to set priorities for adaptive approaches; to examine evidence collection approaches; to clarify the roles and responsibilities of stakeholders; to understand the implications of adaptive approaches on current legal and ethical standards; to determine costs of such approaches and how they will be met; and to identify differences in applying adaptive approaches to drugs versus medical devices. The Forum also explored the different implications of adaptive approaches for various stakeholders, including patients, regulators, HTA/coverage bodies, health systems, clinicians, and industry. CONCLUSIONS A key outcome of the meeting was a clearer understanding of the opportunities and challenges adaptive approaches present. Furthermore, the Forum brought to light the critical importance of recognizing and including a full range of stakeholders as contributors to a shared decision-making model implicit in adaptive pathways in future discussions on, and implementation of, adaptive approaches.
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Stern M, Bertrand DP, Bignamini E, Corey M, Dembski B, Goss CH, Pressler T, Rault G, Viviani L, Elborn JS, Castellani C. European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis. J Cyst Fibros 2014; 13 Suppl 1:S43-59. [DOI: 10.1016/j.jcf.2014.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hampton TH, Green DM, Cutting GR, Morrison HG, Sogin ML, Gifford AH, Stanton BA, O’Toole GA. The microbiome in pediatric cystic fibrosis patients: the role of shared environment suggests a window of intervention. MICROBIOME 2014; 2:14. [PMID: 25071935 PMCID: PMC4113139 DOI: 10.1186/2049-2618-2-14] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 03/27/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is caused by mutations in the CFTR gene that predispose the airway to infection. Chronic infection by pathogens such as Pseudomonas aeruginosa leads to inflammation that gradually degrades lung function, resulting in morbidity and early mortality. In a previous study of CF monozygotic twins, we demonstrate that genetic modifiers significantly affect the establishment of persistent P. aeruginosa colonization in CF. Recognizing that bacteria other than P. aeruginosa contribute to the CF microbiome and associated pathology, we used deep sequencing of sputum from pediatric monozygotic twins and nontwin siblings with CF to characterize pediatric bacterial communities and the role that genetics plays in their evolution. FINDINGS We found that the microbial communities in sputum from pediatric patients living together were much more alike than those from pediatric individuals living apart, regardless of whether samples were taken from monozygous twins or from nontwin CF siblings living together, which we used as a proxy for dizygous twins. In contrast, adult communities were comparatively monolithic and much less diverse than the microbiome of pediatric patients. CONCLUSION Taken together, these data and other recent studies suggest that as patients age, the CF microbiome becomes less diverse, more refractory to treatment and dominated by mucoid P. aeruginosa, as well as being associated with accelerated pulmonary decline. Our studies show that the microbiome of pediatric patients is susceptible to environmental influences, suggesting that interventions to preserve the community structure found in young CF patients might be possible, perhaps slowing disease progression.
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Affiliation(s)
- Thomas H Hampton
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, 615 Remsen Building, N. College St., Hanover, NH 03755, USA
| | - Deanna M Green
- Division of Pediatric Pulmonary and Sleep Medicine, Duke University Medical Center, 350 Hanes House, DUMC Box 102360, Durham NC, USA
| | - Garry R Cutting
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St., Baltimore MD, USA
| | - Hilary G Morrison
- Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, 7 MBL Street, Woods Hole, MA 02543, USA
| | - Mitchell L Sogin
- Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, 7 MBL Street, Woods Hole, MA 02543, USA
| | - Alex H Gifford
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, 615 Remsen Building, N. College St., Hanover, NH 03755, USA
| | - Bruce A Stanton
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, 615 Remsen Building, N. College St., Hanover, NH 03755, USA
| | - George A O’Toole
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, 202 Remsen Building, N. College St., Hanover, NH 03755, USA
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Haack A, Aragão GG, Novaes MRCG. Pathophysiology of cystic fibrosis and drugs used in associated digestive tract diseases. World J Gastroenterol 2013; 19:8552-61. [PMID: 24379572 PMCID: PMC3870500 DOI: 10.3748/wjg.v19.i46.8552] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/28/2013] [Accepted: 10/13/2013] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) causes chronic infections in the respiratory tract and alters the digestive tract. This paper reviews the most important aspects of drug treatment and changes in the digestive tract of patients with CF. This is a review of the literature, emphasizing the discoveries made within the last 15 years by analyzing scientific papers published in journals indexed in the Scientific Electronic Library Online, Sciences Information, United States National Library of Medicine and Medical Literature Analysis and Retrieval System Online databases, both in English and Portuguese, using the key words: cystic fibrosis, medication, therapeutic, absorption, digestion. Randomized, observational, experimental, and epidemiological clinical studies were selected, among others, with statistical significance of 5%. This review evaluates the changes found in the digestive tract of CF patients including pancreatic insufficiency, constipation and liver diseases. Changes in nutritional status are also described. Clinical treatment, nutritional supplementation and drug management were classified in this review as essential to the quality of life of CF patients, and became available through public policies for monitoring and treating CF. The information gathered on CF and a multi professional approach to the disease is essential in the treatment of these patients.
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Microbiology of the middle meatus compared to sputum in young patients with cystic fibrosis from Bahia - Brazil. Braz J Infect Dis 2013; 18:215-9. [PMID: 24275368 PMCID: PMC9427489 DOI: 10.1016/j.bjid.2013.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 07/06/2013] [Accepted: 07/24/2013] [Indexed: 11/22/2022] Open
Abstract
Lower airway infection is a major cause of morbidity and mortality in patients with cystic fibrosis. It is currently unknown if the infection of the upper airway can cause exacerbation of lower respiratory tract infection. This study aimed to determine the microbiological profile of the anterior paranasal sinuses outflow tract (middle meatus) of cystic fibrosis outpatients. The microbiological profile was defined using endoscopically directed middle meatal cultures. Paired middle meatal and sputum specimens were collected from 56 outpatients for aerobic cultures. A semi-quantitative leukocyte count of the middle meatal samples was performed. The median age of patients was nine years (3-20 years). Staphylococcus aureus (37%), Staphylococcus coagulase-negative (25%), Neisseriac (14%), Pseudomonas aeruginosa (11%), and Streptococcus pneumoniae (7%) were the most prevalent microorganisms in the middle meatal cultures. Using the middle meatal leukocyte count, 16 out of 54 patients (29.6%) presented sinus infection. The most frequently identified pathogens in patients with sinus infections were Staphylococcus aureus (10 patients), Pseudomonas aeruginosa (4 patients), and Streptococcus pneumoniae (3 patients). Agreement of paired middle meatal and sputum cultures was significantly higher among patients with infection in middle meatal (69%). The most common middle meatal pathogens were the typical cystic fibrosis spectrum. This suggests the potential for participating in post-nasal lower airway seeding.
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Detection of Achromobacter xylosoxidans in hospital, domestic, and outdoor environmental samples and comparison with human clinical isolates. Appl Environ Microbiol 2013; 79:7142-9. [PMID: 24038696 DOI: 10.1128/aem.02293-13] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Achromobacter xylosoxidans is an aerobic nonfermentative Gram-negative rod considered an important emerging pathogen among cystic fibrosis (CF) patients worldwide and among immunocompromised patients. This increased prevalence remains unexplained, and to date no environmental reservoir has been identified. The aim of this study was to identify potential reservoirs of A. xylosoxidans in hospital, domestic, and outdoor environments and to compare the isolates with clinical ones. From 2011 to 2012, 339 samples were collected in Dijon's university hospital, in healthy volunteers' homes in the Dijon area, and in the outdoor environment in Burgundy (soil, water, mud, and plants). We designed a protocol to detect A. xylosoxidans in environmental samples based on a selective medium: MCXVAA (MacConkey agar supplemented with xylose, vancomycin, aztreonam, and amphotericin B). Susceptibility testing, genotypic analysis by pulsed-field gel electrophoresis, and blaOXA-114 sequencing were performed on the isolates. A total of 50 strains of A. xylosoxidans were detected in hospital (33 isolates), domestic (9 isolates), and outdoor (8 isolates) samples, mainly in hand washing sinks, showers, and water. Most of them were resistant to ciprofloxacin (49 strains). Genotypic analysis and blaOXA-114 sequencing revealed a wide diversity among the isolates, with 35 pulsotypes and 18 variants of oxacillinases. Interestingly, 10 isolates from hospital environment were clonally related to clinical isolates previously recovered from hospitalized patients, and one domestic isolate was identical to one recovered from a CF patient. These results indicate that A. xylosoxidans is commonly distributed in various environments and therefore that CF patients or immunocompromised patients are surrounded by these reservoirs.
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Lima TRL, Guimarães FS, Sá Ferreira A, Penafortes JTS, Almeida VP, Lopes AJ. Correlation between posture, balance control, and peripheral muscle function in adults with cystic fibrosis. Physiother Theory Pract 2013; 30:79-84. [DOI: 10.3109/09593985.2013.820246] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Current Approaches to the Management of Infection in Cystic Fibrosis. CURRENT PEDIATRICS REPORTS 2013. [DOI: 10.1007/s40124-013-0024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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