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van Dorst JM, Tam RY, Ooi CY. What Do We Know about the Microbiome in Cystic Fibrosis? Is There a Role for Probiotics and Prebiotics? Nutrients 2022; 14:nu14030480. [PMID: 35276841 PMCID: PMC8840103 DOI: 10.3390/nu14030480] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
Cystic fibrosis (CF) is a life-shortening genetic disorder that affects the cystic fibrosis transmembrane conductance regulator (CFTR) protein. In the gastrointestinal (GI) tract, CFTR dysfunction results in low intestinal pH, thick and inspissated mucus, a lack of endogenous pancreatic enzymes, and reduced motility. These mechanisms, combined with antibiotic therapies, drive GI inflammation and significant alteration of the GI microbiota (dysbiosis). Dysbiosis and inflammation are key factors in systemic inflammation and GI complications including malignancy. The following review examines the potential for probiotic and prebiotic therapies to provide clinical benefits through modulation of the microbiome. Evidence from randomised control trials suggest probiotics are likely to improve GI inflammation and reduce the incidence of CF pulmonary exacerbations. However, the highly variable, low-quality data is a barrier to the implementation of probiotics into routine CF care. Epidemiological studies and clinical trials support the potential of dietary fibre and prebiotic supplements to beneficially modulate the microbiome in gastrointestinal conditions. To date, limited evidence is available on their safety and efficacy in CF. Variable responses to probiotics and prebiotics highlight the need for personalised approaches that consider an individual’s underlying microbiota, diet, and existing medications against the backdrop of the complex nutritional needs in CF.
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Affiliation(s)
- Josie M. van Dorst
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney 2031, Australia; (J.M.v.D.); (R.Y.T.)
| | - Rachel Y. Tam
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney 2031, Australia; (J.M.v.D.); (R.Y.T.)
| | - Chee Y. Ooi
- Discipline of Paediatrics & Child Health, Randwick Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Sydney 2031, Australia; (J.M.v.D.); (R.Y.T.)
- Molecular and Integrative Cystic Fibrosis (miCF) Research Centre, Sydney 2031, Australia
- Department of Gastroenterology, Sydney Children’s Hospital Randwick, Sydney 2031, Australia
- Correspondence:
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John A, Goździk-Spychalska J, Durda-Masny M, Czaiński W, Pawłowska N, Wlizło J, Batura-Gabryel H, Szwed A. Pseudomonas aeruginosa, the type of mutation, lung function, and nutritional status in adults with cystic fibrosis. Nutrition 2021; 89:111221. [PMID: 33836428 DOI: 10.1016/j.nut.2021.111221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the relationship between the prevalence of Pseudomonas aeruginosa (PA) and lung function, as well as the nutritional status and type of gene mutation in adult patients with cystic fibrosis (CF). METHODS This cross-sectional study evaluated 103 Polish adults with CF the following: • The occurrence of PA and the level of bacterial susceptibility to antibiotics; • Type of mutation in the CFTR gene; • Nutritional status assessed by body mass index (BMI), and • Lung function measured by forced expiratory volume in 1 s (FEV1%). RESULTS The absence or presence of PA and the level of bacterial resistance were significantly related to the type of gene mutation (P < 0.001). In patients with a severe mutation, PA more often was extensively drug resistant or pandrug resistant compared with Pseudomonas culture-negative patients or patients with mild or unclassified mutations on both alleles. Associations were found between the presence of PA and lower values of BMI (P < 0.001), and FEV1% (P < 0.001). The risk for PA occurrence and the development of bacterial resistance increased twice in the case of severe mutation (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.62-3.89), four times when BMI decreased <18.5 (OR, 4.15; 95% CI, 1.43-10.08). and six times when FEV1% fell <40 (OR, 6.75; 95% CI, 3.11-14.64). CONCLUSIONS The presence of PA is associated with lower FEV1% and BMI values. Deterioration of lung function, undernutrition, and severe type of gene mutation are linked to a higher probability of PA acquisition and resistance to antibiotic treatment.
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Affiliation(s)
- Aleksandra John
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan, Poland
| | - Joanna Goździk-Spychalska
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Durda-Masny
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan, Poland
| | - Wojciech Czaiński
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Pawłowska
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan, Poland
| | - Jolanta Wlizło
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Halina Batura-Gabryel
- Department of Pulmonology, Allergology and Respiratory Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anita Szwed
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan, Poland.
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Rodríguez-Calá F, Suárez-Medina R, Venero-Fernández SJ, Smyth A, Carr SB, Fogarty AW. The prevalence, clinical status and genotype of cystic fibrosis patients living in Cuba using national registry data. J Cyst Fibros 2018; 18:522-524. [PMID: 30366848 DOI: 10.1016/j.jcf.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to establish a national cystic fibrosis (CF) registry for Cuba, a developing country. METHODS Regional centres that deliver care for all CF patients provided information for a national database. FINDINGS The prevalence of CF in Cuba is 26.3 cases per 1,000,000 population. The median age at diagnosis is 2 years, and the median age of the total population was 15 years. Of those aged 16 years or older, the prevalence of Pseudomonas aeruginosa infection was 46%, the prevalence of Staphylococcus aureus infection was 36%, and 80% of individuals were receiving oral azithromycin. The commonest gene mutation was F508del which was observed in 50% of patients. INTERPRETATION These data demonstrate that it is possible to establish a national CF registry in a developing country such as Cuba. This provides baseline data to permit evaluation of health care delivery enable the spread of good clinical practice nationally.
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Affiliation(s)
- Fidel Rodríguez-Calá
- Hospital Universitario "General Calixto García", Avenida Universidad y J, Plaza, Código Postal, 10400 La Habana, Cuba.
| | - Ramón Suárez-Medina
- Instituto Nacional de Higiene, Epidemiología y Microbiología, Infanta No 1158 e/ Llinas y Clavel, Código Postal, 10300 La Habana, Cuba
| | - Silvia Josefina Venero-Fernández
- Instituto Nacional de Higiene, Epidemiología y Microbiología, Infanta No 1158 e/ Llinas y Clavel, Código Postal, 10300 La Habana, Cuba
| | - Alan Smyth
- Division of Child Health, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
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Papalexopoulou N, Dassios TG, Lunt A, Bartlett F, Perrin F, Bossley CJ, Wyatt HA, Greenough A. Nutritional status and pulmonary outcome in children and young people with cystic fibrosis. Respir Med 2018; 142:60-65. [PMID: 30170803 DOI: 10.1016/j.rmed.2018.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nutrition is closely related to mortality and pulmonary and respiratory muscle function in cystic fibrosis (CF) patients. We initially validated results from a bioelectrical impedance device against dual energy x-ray absorptiometry (DEXA). We then determined whether fat free mass assessed by a portable impedance device rather than body mass index (BMI) better correlated with pulmonary function, respiratory muscle strength and exercise capacity in CF patients. METHODS Eighteen young people and adults (median age 19, range 12-39 years) with CF had dual energy X-ray absorptiometry and direct segmental multi-frequency impedance analysis. Body composition, pulmonary function, respiratory muscle function and exercise tolerance using the impedance device were measured in 29 young people with CF with median age 15 (range 12-19) years. MAIN FINDINGS There was a significant correlation between impedance and absorptiometry results (r2 = 0.947). Fat free mass correlated with the forced vital capacity z-score (r = 0.442, p = 0.016), maximal inspiratory pressure (r = 0.451, p = 0.014) and exercise tolerance (r = 0. 707, p < 0.001). BMI z-scores did not significantly correlate with pulmonary or respiratory muscle function. Subjects with a fat free mass z-score of ≤2 had a lower forced expiratory volume in 1 s z-score (p = 0.007), lower forced vital capacity z-score (p = 0.001), higher residual volume z-score (p = 0.042), lower maximal inspiratory pressure (p = 0.039), more days of intravenous antibiotics per year (p = 0.016) and a higher rate of chronic infections (p = 0.006). PRINCIPAL CONCLUSIONS Fat-free mass measured by impedance correlated better with pulmonary and respiratory muscle function and exercise capacity than BMI.
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Affiliation(s)
- Niovi Papalexopoulou
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | - Theodore G Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Alan Lunt
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | - Fiona Bartlett
- Paediatric Dietetic Department, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Felicity Perrin
- Respiratory Medicine and Adult Cystic Fibrosis Service, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Cara J Bossley
- Paediatric Respiratory Medicine, Kings College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Hilary A Wyatt
- Paediatric Cystic Fibrosis, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Anne Greenough
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, United Kingdom; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom.
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Barr HL, Cámara M, Barrett D, Williams P, Forrester D, Smyth A, Honeybourne D, Whitehouse J, Nash E, Dewar J, Knox A, Fogarty AW. Weight gain during acute treatment of an initial pulmonary exacerbation is associated with a longer interval to the next exacerbation in adults with cystic fibrosis. ERJ Open Res 2017; 3:00057-2017. [PMID: 28852645 PMCID: PMC5572946 DOI: 10.1183/23120541.00057-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Cystic fibrosis (CF) results in a variety of clinical phenotypes, including increased susceptibility to pulmonary infections [1] and malnutrition [2]. As a consequence, one of the priorities in the clinical care for individuals with a diagnosis of CF is to treat chest infections promptly [3], with the aim of minimising the decline in lung function that occurs in individuals who experience recurrent pulmonary exacerbations [4]. Optimising nutrition is another important consideration in the care of patients with CF [3]. It is well recognised that nutritional status and lung function are correlated [5] and that individuals with lower levels of nutrition have increased mortality [6] compared to those individuals with better nutrition. Weight gain during treatment for a cystic fibrosis exacerbationhttp://ow.ly/f1zl30dU9AO
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Affiliation(s)
- Helen L Barr
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Miguel Cámara
- Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - David Barrett
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Paul Williams
- Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Doug Forrester
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Alan Smyth
- Department of Child Health, University of Nottingham, Nottingham, UK
| | - David Honeybourne
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Joanna Whitehouse
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Edward Nash
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jane Dewar
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Knox
- Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | - Andrew W Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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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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Darrah R, Nelson R, Damato EG, Decker M, Matthews A, Hodges CA. Growth Deficiency in Cystic Fibrosis Is Observable at Birth and Predictive of Early Pulmonary Function. Biol Res Nurs 2016; 18:498-504. [PMID: 27081158 DOI: 10.1177/1099800416643585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a complex disease that includes both pulmonary and gastrointestinal challenges, resulting in decreased weight. Pulmonary symptoms of CF are extremely variable. Greater body mass at an early age is associated with improved pulmonary function, but it is unknown at what age weight becomes predictive of pulmonary disease severity. The purpose of this study was to investigate the relationship between birth weight and pulmonary function in CF. METHODS Birth weight and pulmonary data were obtained. Linear regressions were used to examine the relationship between these two variables. A one-tailed t-test was used to compare birth weights between CF patients and the national average. RESULTS Birth weight was significantly lower in babies with CF and correlated with pulmonary disease at ages 6 and 10 years but not with age at which Pseudomonas aeruginosa colonization was observed. DISCUSSION These data suggest that CF growth deficiency has prenatal origins. Early nutritional intervention for babies with CF and a low birth weight is warranted to maximize pulmonary potential.
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Affiliation(s)
- Rebecca Darrah
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Co-first authors
| | - Rebecca Nelson
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Co-first authors
| | - Elizabeth G Damato
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Decker
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Anne Matthews
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Craig A Hodges
- Department of Genetics, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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