1
|
Bryrup T, Faurholt-Jepsen D, Pressler T, Henriksen EH, Leo-Hansen C, Nielsen BU, Højte C, Mathiesen IHM, Katzenstein TL, Jeppesen M, Jensen-Fangel S, Olesen HV, Skov M, Qvist T, Olsen MF. Real-world data confirm elexacftor/tezacaftor/ivacaftor modulators halves sweat chloride concentration in eligible people with cystic fibrosis. APMIS 2024. [PMID: 39092470 DOI: 10.1111/apm.13453] [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: 01/05/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024]
Abstract
Sweat chloride concentration, a diagnostic feature in cystic fibrosis (CF), reflects CF transmembrane conductance regulator (CFTR) activity. CFTR modulator therapies, especially elexacaftor/tezacaftor/ivacaftor (ETI), has improved CF outcomes. We report nationwide, real-world data on sweat chloride concentration in people with CF (pwCF) with and without modulator therapies. All Danish pwCF with a minimum of one F508del allele were included. Sweat chloride measurements were stratified by genotype and modulator treatment. Differences were assessed using mixed-effects models. We included 977 sweat chloride measurements from 430 pwCF, 71% of which were F508del homozygous. Heterozygous and homozygous ETI-treated pwCF had an estimated mean sweat chloride concentration of 43 mmol/L (95% confidence interval: 39; 48) and 43 mmol/L (39; 47), respectively-48% and 59% lower than those without treatment. High variation in concentrations remained regardless of treatment status. Despite ETI treatment, 27% heterozygous and 23% homozygous pwCF had elevated concentrations (≥60 mmol/L). These real-world data confirm a substantial decrease in sweat chloride concentration during modulator treatment, especially ETI, where mean concentrations halved. However, large variation remained, including persistently high concentrations. These findings emphasize the potential of sweat chloride concentration as a treatment response biomarker and the need to explore its heterogeneity and relationship with clinical outcomes.
Collapse
Affiliation(s)
- Thomas Bryrup
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tacjana Pressler
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Esben Herborg Henriksen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Leo-Hansen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Bibi Uhre Nielsen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christine Højte
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Inger Hee Mabuza Mathiesen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Terese L Katzenstein
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Majbritt Jeppesen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Jensen-Fangel
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Vebert Olesen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Skov
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Tavs Qvist
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Mette Frahm Olsen
- The Danish Cystic Fibrosis Cohort, Copenhagen, Aarhus, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Anton-Păduraru DT, Azoicăi AN, Trofin F, Mîndru DE, Murgu AM, Bocec AS, Iliescu Halițchi CO, Ciongradi CI, Sȃrbu I, Iliescu ML. Diagnosing Cystic Fibrosis in the 21st Century-A Complex and Challenging Task. Diagnostics (Basel) 2024; 14:763. [PMID: 38611676 PMCID: PMC11012009 DOI: 10.3390/diagnostics14070763] [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: 03/04/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Cystic fibrosis (CF) is a chronic and potentially life-threatening condition, wherein timely diagnosis assumes paramount significance for the prompt initiation of therapeutic interventions, thereby ameliorating pulmonary function, addressing nutritional deficits, averting complications, mitigating morbidity, and ultimately enhancing the quality of life and extending longevity. This review aims to amalgamate existing knowledge to provide a comprehensive appraisal of contemporary diagnostic modalities pertinent to CF in the 21st century. Deliberations encompass discrete delineations of each diagnostic modality and the elucidation of potential diagnostic quandaries encountered in select instances, as well as the delineation of genotype-phenotype correlations germane to genetic counseling endeavors. The synthesis underscores that, notwithstanding the availability and strides in diagnostic methodologies, including genetic assays, the sweat test (ST) retains its position as the preeminent diagnostic standard for CF, serving as a robust surrogate for CFTR functionality. Prospective clinical investigations in the realm of CF should be orchestrated with the objective of discerning novel diagnostic modalities endowed with heightened specificity and sensitivity.
Collapse
Affiliation(s)
- Dana-Teodora Anton-Păduraru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Alice Nicoleta Azoicăi
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Felicia Trofin
- Department of Preventive Medicine and Interdisciplinarity—Microbiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Dana Elena Mîndru
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Alina Mariela Murgu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
| | - Ana Simona Bocec
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
| | - Codruța Olimpiada Iliescu Halițchi
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania; (D.-T.A.-P.); (A.N.A.); (D.E.M.); (A.M.M.); (A.S.B.); (C.O.I.H.)
| | - Carmen Iulia Ciongradi
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
- 2nd Department of Surgery, Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Ioan Sȃrbu
- “Sf.Maria” Children Emergency Hospital, 700309 Iaṣi, Romania; (C.I.C.); (I.S.)
- 2nd Department of Surgery, Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania
| | - Maria Liliana Iliescu
- Department of Preventive Medicine and Interdisciplinarity—Public Health and Health Management, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaṣi, Romania;
| |
Collapse
|
3
|
Patel V, Mardolkar A, Shelar A, Tiwari R, Srivastava R. Wearable sweat chloride sensors: materials, fabrication and their applications. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:1439-1453. [PMID: 38411394 DOI: 10.1039/d3ay01979a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Chloride is a crucial anion required for multiple functions in the human body including maintaining acid-base balance, fluid balance, electrical neutrality and supporting muscles and nerve cells. Low-chloride levels can cause nausea, diarrhoea, etc. Chloride levels are measured in different body fluids such as urine, serum, sweat and saliva. Sweat chloride measurements are used for multiple applications including disease diagnosis, sports monitoring, and geriatric care. For instance, a sweat chloride test is performed for cystic fibrosis screening. Further, sweat also offers continuous non-invasive access to body fluids for real-time monitoring of chloride that could be used for sports and geriatric care. This review focuses on wearable chloride sensors that are used for periodic and continuous chloride monitoring. The multiple sections in the paper discuss the clinical significance of chloride, detection methods, sensor fabrication methods and their application in cystic fibrosis screening, sports and geriatric care. Finally, the last section discusses the limitation of current sensors and future directions for wearable chloride sensors.
Collapse
Affiliation(s)
- Vinay Patel
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, India, 400076.
| | - Anvi Mardolkar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, India, 400076.
| | - Akshata Shelar
- St. Xavier's College, Autonomous, Mumbai, Maharashtra 400001, India
| | - Ritu Tiwari
- Guru Nanak Khalsa College, Matunga East, Mumbai, Maharashtra 400019, India
| | - Rohit Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, India, 400076.
| |
Collapse
|
4
|
Brazaca LC, Imamura AH, Blasques RV, Camargo JR, Janegitz BC, Carrilho E. The use of biological fluids in microfluidic paper-based analytical devices (μPADs): Recent advances, challenges and future perspectives. Biosens Bioelectron 2024; 246:115846. [PMID: 38006702 DOI: 10.1016/j.bios.2023.115846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
The use of microfluidic paper-based analytical devices (μPADs) for aiding medical diagnosis is a growing trend in the literature mainly due to their low cost, easy use, simple manufacturing, and great potential for application in low-resource settings. Many important biomarkers (proteins, ions, lipids, hormones, DNA, RNA, drugs, whole cells, and more) and biofluids are available for precise detection and diagnosis. We have reviewed the advances μPADs in medical diagnostics have achieved in the last few years, focusing on the most common human biofluids (whole blood/plasma, sweat, urine, tears, and saliva). The challenges of detecting specific biomarkers in each sample are discussed, along with innovative techniques that overcome such limitations. Finally, the difficulties of commercializing μPADs are considered, and future trends are presented, including wearable devices and integrating multiple steps in a single platform.
Collapse
Affiliation(s)
- Laís Canniatti Brazaca
- Instituto de Química de São Carlos, Universidade de São Paulo, São Carlos, SP, 13566-590, Brazil.
| | - Amanda Hikari Imamura
- Instituto de Química de São Carlos, Universidade de São Paulo, São Carlos, SP, 13566-590, Brazil; Instituto Nacional de Ciência e Tecnologia de Bioanalítica-INCTBio, Campinas, SP, 13083-970, Brazil
| | - Rodrigo Vieira Blasques
- Departamento de Ciências da Natureza, Matemática e Educação, Universidade Federal de São Carlos, Araras, SP, 13600-970, Brazil
| | - Jéssica Rocha Camargo
- Departamento de Ciências da Natureza, Matemática e Educação, Universidade Federal de São Carlos, Araras, SP, 13600-970, Brazil
| | - Bruno Campos Janegitz
- Departamento de Ciências da Natureza, Matemática e Educação, Universidade Federal de São Carlos, Araras, SP, 13600-970, Brazil
| | - Emanuel Carrilho
- Instituto de Química de São Carlos, Universidade de São Paulo, São Carlos, SP, 13566-590, Brazil; Instituto Nacional de Ciência e Tecnologia de Bioanalítica-INCTBio, Campinas, SP, 13083-970, Brazil
| |
Collapse
|
5
|
Xu W, Wu T, Zhou Z, Zuo Z. Efficacy and safety profile of elexacaftor-tezacaftor-ivacaftor triple therapy on cystic fibrosis: a systematic review and single arm meta-analysis. Front Pharmacol 2023; 14:1275470. [PMID: 38186649 PMCID: PMC10768559 DOI: 10.3389/fphar.2023.1275470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024] Open
Abstract
Background: Elexacaftor-Tezacaftor-Ivacaftor (ELE/TEZ/IVA) is believed to be an effective and well-tolerated treatment for cystic fibrosis (CF), but the exact efficacy and safety profile are still unknown. Objective: This study aimed to clarify the extent of functional restoration when patients are given with triple combination treatment and demonstrate the prevalence of adverse events, to evaluate the overall profile of ELE/TEZ/IVA on CF. Methods: A literature search was conducted in PubMed, Web of Science and Cochrane Library. Random effects single-arm meta-analysis was performed to decipher the basal characteristics of CF, the improvement and safety profile after ELE/TEZ/IVA treatment. Results: A total 53 studies were included in this analysis. For all the patients in included studies. 4 weeks after ELE/TEZ/IVA treatment, the increasement of percentage of predicted Forced Expiratory Volume in the first second (ppFEV1) was 9.23% (95%CI, 7.77%-10.70%), the change of percentage of predicted Forced Vital Capacity (ppFVC) was 7.67% (95%CI, 2.15%-13.20%), and the absolute change of Cystic Fibrosis Questionnaire-Revised (CFQ-R) score was 21.46 points (95%CI, 18.26-24.67 points). The Sweat chloride (SwCl) was significantly decreased with the absolute change of -41.82 mmol/L (95%CI, -44.38 to -39.25 mmol/L). 24 weeks after treatment, the increasement of ppFEV1 was 12.57% (95%CI, 11.24%-13.90%), the increasement of ppFVC was 10.44% (95%CI, 7.26%-13.63%), and the absolute change of CFQ-R score was 19.29 points (95%CI, 17.19-21.39 points). The SwCl was significantly decreased with the absolute change of -51.53 mmol/L (95%CI, -56.12 to -46.94 mmol/L). The lung clearance index2.5 (LCI2.5) was also decreased by 1.74 units (95%CI, -2.42 to -1.07 units). The body mass index increased by 1.23 kg/m2 (95%CI, 0.89-1.57 kg/m2). As for adverse events, 0.824 (95%CI, 0.769-0.879) occurred during ELE/TEZ/IVA period, while the incidence of severe adverse events was 0.066 (95%CI, 0.028-0.104). Conclusion: ELE/TEZ/IVA is a highly effective strategy and relatively safe for CF patients and needs to be sustained to achieve better efficacy. Systematic Review Registration: Identifier: CRD42023441840.
Collapse
Affiliation(s)
- Wenye Xu
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Molecular Precision Medicine, Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ting Wu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zijing Zhou
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhihong Zuo
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Molecular Precision Medicine, Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
6
|
Novel Retro-Inverso Peptide Antibiotic Efficiently Released by a Responsive Hydrogel-Based System. Biomedicines 2022; 10:biomedicines10061301. [PMID: 35740323 PMCID: PMC9219916 DOI: 10.3390/biomedicines10061301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Topical antimicrobial treatments are often ineffective on recalcitrant and resistant skin infections. This necessitates the design of antimicrobials that are less susceptible to resistance mechanisms, as well as the development of appropriate delivery systems. These two issues represent a great challenge for researchers in pharmaceutical and drug discovery fields. Here, we defined the therapeutic properties of a novel peptidomimetic inspired by an antimicrobial sequence encrypted in human apolipoprotein B. The peptidomimetic was found to exhibit antimicrobial and anti-biofilm properties at concentration values ranging from 2.5 to 20 µmol L−1, to be biocompatible toward human skin cell lines, and to protect human keratinocytes from bacterial infections being able to induce a reduction of bacterial units by two or even four orders of magnitude with respect to untreated samples. Based on these promising results, a hyaluronic-acid-based hydrogel was devised to encapsulate and to specifically deliver the selected antimicrobial agent to the site of infection. The developed hydrogel-based system represents a promising, effective therapeutic option by combining the mechanical properties of the hyaluronic acid polymer with the anti-infective activity of the antimicrobial peptidomimetic, thus opening novel perspectives in the treatment of skin infections.
Collapse
|
7
|
3D Printed Skin-Wash Sampler for Sweat Sampling in Cystic Fibrosis Diagnosis Using Capillary Electrophoretic Ion Ratio Analysis. SEPARATIONS 2021. [DOI: 10.3390/separations8120234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sweat chloride analysis is one of the important approaches in cystic fibrosis diagnosis. The commonly used Macroduct method to acquire sweat samples is semi-invasive, time consuming and expensive. Furthermore, this method often fails to collect a sufficient amount of sweat in newborns due to the insufficient sweating rate. In this work, we present a novel, simple, 3D-printed sampling device that is used to collect sweat specimens completely noninvasively in less than one minute. The device has a flow-through channel adjacent to the skin surface, through which 500 µL of deionized water is flushed and the spontaneously formed sweat on the skin in the channel area is washed into a plastic vial. The developed skin-wash procedure is a single step operation, is completely noninvasive and it always produces a sweat specimen. The ions from the skin-wash are subsequently analyzed by capillary electrophoresis with contactless conductivity detection and selected ion ratio (Cl−/K+) or ((Cl− + Na+)/K+) is used as a cut-off value to diagnose cystic fibrosis patients with sensitivity and specificity comparable to the conventional Macroduct method.
Collapse
|
8
|
Cimbalo C, Tosco A, Terlizzi V, Sepe A, Castaldo A, Salvadori L, Raia V. Elevated sweat chloride test: is it always cystic fibrosis? Ital J Pediatr 2021; 47:112. [PMID: 33990208 PMCID: PMC8120719 DOI: 10.1186/s13052-021-01060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The sweat chloride test (ST) is the gold standard for cystic fibrosis (CF) diagnosis in symptomatic patients, within the newborn screening and in the follow-up of CF patients during molecular therapies. However, false positives have been reported in patients with different diseases. We describe and discuss 4 cases due to different clinical conditions in which we recorded false positive ST, and the test remained altered for a period of varying length. CASES PRESENTATION Case 1: Eight months old female child suffering from constipation, recurrent vomiting and failure to thrive, family history of recurrent pancreatitis without mutations in the PRSS1 and SPINK1 genes. Both ST and fecal elastase were altered although no CFTR gene mutations were found. Due to rapid clinical deterioration, celiac disease was suspected and diagnosed by laboratory tests and intestinal biopsy. After 2 weeks of gluten-free diet ST and fecal elastase normalized. Case 2: 14 months old male suffering from bilateral renal dysplasia, episodes of metabolic alkalosis, recurrent respiratory infections and recurrent vomiting. The child had more ST positives, but no CFTR mutations were found. During follow-up, he developed sensorineural hearing loss and an atrial septic defect was found. Finally, a diagnosis of Klinefelter was made, but the ST normalized several years later. Case 3 and 4: Two boys with stubborn constipation and fecal occlusion treated with Poly Ethylene Glycol (PEG) with salts showed pathological ST. The test returned normal a few days after stopping treatment. CONCLUSIONS We hypotesized the possible causes of ST alteration in these conditions: in celiac disease it could be due to a transient dysregulation of the aquaporins, rapidly reversed by the diet; in Klinefelter, it may be due to stable pubertal hypoandrogenism; while, the PEG formulation itself contains salts that can temporarily alter ST.
Collapse
Affiliation(s)
- C Cimbalo
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy.
| | - A Tosco
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy
| | - V Terlizzi
- Department of Paediatric Medicine, Cystic Fibrosis Centre, Anna Meyer Children's University Hospital, Florence, Italy
| | - A Sepe
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy
| | - A Castaldo
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy
| | - L Salvadori
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy
| | - V Raia
- Department of Translational Medical Sciences, Cystic Fibrosis Center, University Federico II, Naples, Italy
| |
Collapse
|
9
|
Zemanick ET, Konstan MW, VanDevanter DR, Rowe SM, Clancy JP, Odem-Davis K, Skalland M, Mayer-Hamblett N. Measuring the impact of CFTR modulation on sweat chloride in cystic fibrosis: Rationale and design of the CHEC-SC study. J Cyst Fibros 2021; 20:965-971. [PMID: 33573995 DOI: 10.1016/j.jcf.2021.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Characterizing CFTR Modulated Changes in Sweat Chloride and their Association with Clinical Outcomes (CHEC-SC) study is a large epidemiologic study designed to determine the relationship between sweat chloride response and clinical outcomes in people with cystic fibrosis (CF) on commercially approved CFTR modulators. A challenge to study feasibility was capturing sweat chloride measurements before modulator initiation. We tested the hypothesis that historic sweat chloride approximated contemporary pre-modulator values to estimate CFTR modulator-induced changes, allowing a single-visit study design. METHODS GOAL and PROSPECT were multi-center prospective studies of individuals initiating ivacaftor or lumacaftor-ivacaftor. At enrollment, pre-modulator sweat chloride was measured and historic results recorded. Post-modulator sweat chloride was measured at 1, 3 and 6 months. For this analysis, differences between historic and pre-modulator sweat chloride were estimated. CFTR modulator-induced sweat chloride mean changes were compared using historic and pre-modulator sweat chloride. RESULTS Paired historic and pre-modulator sweat chloride (n=406 participants) revealed a non-significant mean change of -1.0 mmol/L (95% CI: -2.71, 0.66) over an average of 17.2 years. Calculating sweat response to ivacaftor or lumacaftor-ivacaftor using historic or pre-modulator values resulted in similar estimates of modulator response. Based on these results, the CHEC-SC study was designed with a single, post-modulator sweat chloride measurement. CONCLUSIONS Historic sweat chloride values provide a reliable estimate of pre-modulator sweat chloride for people starting on modulator therapy. The CHEC-SC study anticipates capturing approximately 5,000 sweat chloride values, providing an unprecedented understanding of sweat chloride across the CF population in the era of CFTR modulators.
Collapse
Affiliation(s)
- Edith T Zemanick
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Michael W Konstan
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland OH USA; Rainbow Babies and Children's Hospital, Cleveland OH USA
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland OH USA
| | - Steven M Rowe
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL USA
| | - J P Clancy
- Cystic Fibrosis Foundation, Bethesda, MD USA
| | | | | | - Nicole Mayer-Hamblett
- Seattle Children's Research Institute, Seattle, WA 98145, USA; Department of Biostatistics and Pediatrics, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
10
|
Ďurč P, Foret F, Homola L, Malá M, Pokojová E, Vinohradská H, Dastych M, Krausová D, Nagy D, Bede O, Dřevínek P, Skalická V, Kubáň P. Skin wipe test: A simple, inexpensive, and fast approach in the diagnosis of cystic fibrosis. Pediatr Pulmonol 2020; 55:1653-1660. [PMID: 32250037 DOI: 10.1002/ppul.24758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the performance of a newly developed skin wipe test (SWT) for the diagnosis of cystic fibrosis (CF). STUDY DESIGN Spontaneously formed sweat from the forearm was wiped by a cotton swab moistened with 100 µL of deionized (DI) water and extracted into 400 µL of DI water (SWT). The conventional Macroduct sweat test (ST) was performed simultaneously. SWT samples of 114 CF patients, 76 healthy carriers, and 58 controls were analyzed by capillary electrophoresis with contactless conductivity detection and Cl- /K+ and (Cl- + Na+ )/K+ ion ratios were evaluated. Chloride concentrations from Macroduct ST were analyzed coulometrically. RESULTS Analysis of 248 SWT samples and simultaneous Macroduct ST samples showed comparable method performance. Two ion ratios, Cl- /K+ and (Cl- + Na+ )/K+ , from the SWT samples and Cl- values from the ST samples were evaluated to diagnose CF. Sensitivity of the SWT method using the Cl- /K+ ratio (cutoff value 3.9) was 93.9%, compared to 99.1% when using the (Cl- + Na+ )/K+ ratio (cutoff value 5.0) and 98.3% in using Macroduct Cl- (cutoff value higher or equal to 60 mmol/L). The methods' specificities were 97.8%, 94.0%, and 100.0%, respectively. CONCLUSIONS The developed SWT method with capillary electrophoretic analysis for CF diagnosis performs comparably to the conventional Macroduct ST. The SWT method is simple, fast, inexpensive, and completely noninvasive. Use of an ion ratio in obtained SWT samples is proposed as a new diagnostic parameter that shows significant promise in CF diagnostics.
Collapse
Affiliation(s)
- Pavol Ďurč
- Department of Bioanalytical Instrumentation, CEITEC Masaryk University, Brno, Czech Republic.,Department of Chemistry, Masaryk University Brno, Czech Republic
| | - František Foret
- Department of Bioanalytical Instrumentation, CEITEC Masaryk University, Brno, Czech Republic
| | - Lukáš Homola
- Cystic Fibrosis Centre and Clinic of Pediatric Infectious Diseases, University Hospital Brno, Brno, Czech Republic
| | - Miriam Malá
- Cystic Fibrosis Centre and Clinic of Pediatric Infectious Diseases, University Hospital Brno, Brno, Czech Republic
| | - Eva Pokojová
- Department of Respiratory Diseases and TB, University Hospital Brno, Brno, Czech Republic
| | - Hana Vinohradská
- Department of Clinical Biochemistry, University Hospital Brno, Brno, Czech Republic
| | - Milan Dastych
- Department of Clinical Biochemistry, University Hospital Brno, Brno, Czech Republic
| | - Dagmar Krausová
- Cystic Fibrosis Centre and Clinic of Pediatric Infectious Diseases, University Hospital Brno, Brno, Czech Republic
| | - Dóra Nagy
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Olga Bede
- Bács-Kiskun County Hospital and Teaching Hospital, University of Szeged, Kecskemét, Hungary
| | - Pavel Dřevínek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Veronika Skalická
- Department of Pediatrics, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Kubáň
- Department of Bioanalytical Instrumentation, CEITEC Masaryk University, Brno, Czech Republic
| |
Collapse
|
11
|
Doull I. Devil in the detail of newborn screening for cystic fibrosis. Arch Dis Child 2019; 104:938-940. [PMID: 30389674 DOI: 10.1136/archdischild-2018-316247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/18/2018] [Accepted: 10/21/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Iolo Doull
- Department of Paediatric Respiratory Medicine and Paediatric Cystic, Childrens Hospital for Wales, Cardiff, UK.,Welsh Health Specialist Services, Caerphilly, UK
| |
Collapse
|
12
|
Baker LB. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature (Austin) 2019; 6:211-259. [PMID: 31608304 PMCID: PMC6773238 DOI: 10.1080/23328940.2019.1632145] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
The purpose of this comprehensive review is to: 1) review the physiology of sweat gland function and mechanisms determining the amount and composition of sweat excreted onto the skin surface; 2) provide an overview of the well-established thermoregulatory functions and adaptive responses of the sweat gland; and 3) discuss the state of evidence for potential non-thermoregulatory roles of sweat in the maintenance and/or perturbation of human health. The role of sweating to eliminate waste products and toxicants seems to be minor compared with other avenues of excretion via the kidneys and gastrointestinal tract; as eccrine glands do not adapt to increase excretion rates either via concentrating sweat or increasing overall sweating rate. Studies suggesting a larger role of sweat glands in clearing waste products or toxicants from the body may be an artifact of methodological issues rather than evidence for selective transport. Furthermore, unlike the renal system, it seems that sweat glands do not conserve water loss or concentrate sweat fluid through vasopressin-mediated water reabsorption. Individuals with high NaCl concentrations in sweat (e.g. cystic fibrosis) have an increased risk of NaCl imbalances during prolonged periods of heavy sweating; however, sweat-induced deficiencies appear to be of minimal risk for trace minerals and vitamins. Additional research is needed to elucidate the potential role of eccrine sweating in skin hydration and microbial defense. Finally, the utility of sweat composition as a biomarker for human physiology is currently limited; as more research is needed to determine potential relations between sweat and blood solute concentrations.
Collapse
Affiliation(s)
- Lindsay B. Baker
- Gatorade Sports Science Institute, PepsiCo R&D Physiology and Life Sciences, Barrington, IL, USA
| |
Collapse
|
13
|
Dubot P, Liang J, Dubs J, Missiak Y, Sarazin C, Couderc F, Caussé E. Sweat chloride quantification using capillary electrophoresis. Pract Lab Med 2018; 13:e00114. [PMID: 30623007 PMCID: PMC6317274 DOI: 10.1016/j.plabm.2018.e00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/06/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
Background Cystic fibrosis (CF) is the less rare and severe genetic disease among the European population. Biochemical diagnosis of CF is based on the demonstration of increased chloride concentration in sweat samples, obtained during the sweat test (ST). WynSep developed a capillary electrophoresis with contactless conductivity detection (CE-C4D) able to measure sweat chloride with a low sample volume. We evaluated the clinical feasibility of this device in a cohort of patients suspected of CF, in comparison with the common coulometric method (ChloroChek chloridometer). Methods We determined sweat chloride concentration of 65 samples from patients referred to our institution to undergo a sweat test. Each sample was submitted to coulometric method first, then WynSep-CE, with or without internal standard (IS) subject to sufficient volume sample. Results A total of 53 samples were analysed by both coulometric and WynSep-CE (using IS) methods. The method validation showed comparable analytical performances for both methods; no false positive or false negative was recorded. The two methods showed a high correlation (r = 0.993, p < 0.001) and a close agreement was demonstrated by two different statistical tests (Bland-Altman and Passing-Bablok). Conclusions WynSep-CE is an accurate, fast, easy-to-use and an appropriate method for CF diagnosis.
Collapse
Affiliation(s)
- Patricia Dubot
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
| | - Jing Liang
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - Jacobé Dubs
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - Yohann Missiak
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
| | - Cédric Sarazin
- WynSep SAS, Prologue 1, 815 La Pyrénéenne, 31670 Labège, France
| | - François Couderc
- Laboratoire de Chimie Analytique et Spectrométrie de Masse, IMRCP, UMR, 5623 Toulouse, France
| | - Elizabeth Caussé
- Laboratoire de Biochimie, Institut Fédératif de Biologie, Hôpital Purpan, 330, av de Grande Bretagne TSA 40031, 31059 Toulouse Cedex 9, France
- Corresponding author.
| |
Collapse
|
14
|
Gramegna A, Aliberti S, Seia M, Porcaro L, Bianchi V, Castellani C, Melotti P, Sorio C, Consalvo E, Franceschi E, Amati F, Contarini M, Gaffuri M, Roncoroni L, Vigone B, Bellofiore A, Del Monaco C, Oriano M, Terranova L, Patria MF, Marchisio P, Assael BM, Blasi F. When and how ruling out cystic fibrosis in adult patients with bronchiectasis. Multidiscip Respir Med 2018; 13:29. [PMID: 30151190 PMCID: PMC6101074 DOI: 10.1186/s40248-018-0142-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Bronchiectasis is the final result of different processes and most of the guidelines advocate for a careful evaluation of those etiologies which might be treated or might change patients’ management, including cystic fibrosis (CF). Main body CFTR mutations have been reported with higher frequency in bronchiectasis population. Although ruling out CF is considered as a main step for etiological screening in bronchiectasis, CF testing lacks of a standardized approach both from a research and clinical point of view. In this review a list of most widely used tests in CF is provided. Conclusions Exclusion of CF is imperative for patients with bronchiectasis and CFTR testing should be implemented in usual screening for investigating bronchiectasis etiology. Physicians taking care of bronchiectasis patients should be aware of CFTR testing and its limitations in the adult population. Further studies on CFTR expression in human lung and translational research might elucidate the possible role of CFTR in the pathogenesis of bronchiectasis.
Collapse
Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Manuela Seia
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luigi Porcaro
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Vera Bianchi
- 3UOSD Genetica Medica, Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Castellani
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paola Melotti
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Sorio
- 5Dipartimento di Patologia e Diagnostica, Università di Verona, Verona, Italy
| | - Enza Consalvo
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Franceschi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Amati
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Contarini
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Michele Gaffuri
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Roncoroni
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Barbara Vigone
- 7Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Angela Bellofiore
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Cesare Del Monaco
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Oriano
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.,9Molecular Medicine Department, University of Pavia, Viale Taramelli 3/b, 27100 Pavia, Italy
| | - Leonardo Terranova
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Baroukh M Assael
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| |
Collapse
|
15
|
Cirilli N, Raia V, Rocco I, De Gregorio F, Tosco A, Salvadori L, Sepe AO, Buzzetti R, Minicuci N, Castaldo G. Intra-individual biological variation in sweat chloride concentrations in CF, CFTR dysfunction, and healthy pediatric subjects. Pediatr Pulmonol 2018; 53:728-734. [PMID: 29611353 DOI: 10.1002/ppul.23992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The sweat test is one of the main diagnostic tools used in newborn screening programs and as a confirmatory test, in case of suspect of Cystic Fibrosis (CF). Since sweat chloride (Cl) concentration is also considered an appropriate parameter to explore the efficacy of CFTR modulators in clinical trials, it is crucial to evaluate the biological variability of this test in healthy and pathological conditions. The aim of this pilot study was to determine the intra-individual biological variability of sweat Cl, both in healthy individuals and CF patients and to assess its correlation with diet, season, and menstrual cycle. METHODS Thirty-five out of 36 selected subjects (6-18 years) were enrolled by 2 CF care centers and assigned to 3 cohorts: CF, CFTR-related disorder (CFTR-RD) and healthy volunteers. Each participant was subjected to eight sweat tests in different conditions and time of the year. Data were analyzed using linear mixed effects models for repeated measures, taking also into account intra-individual correlations. RESULTS We observed a high intra-individual variability of sweat Cl, with the lowest mean CV% values among CF patients (20.21 in CF, 29.74 in CFTR-RD, and 31.15 in healthy subjects). Gender and diet had no influence on sweat Cl variability, nor had pubertal age and menstrual phase. CONCLUSION Results of this pilot study confirmed that sweat Cl variability is high in CF patients, although non-CF individuals displayed even higher mean CV% values. Season significantly influenced sweat test values only in CF patients, likely due to changes in their hydration status.
Collapse
Affiliation(s)
- Natalia Cirilli
- Mother-Child Department, Cystic Fibrosis Referral Care Center, United Hospitals, Ancona, Italy
| | - Valeria Raia
- Regional Cystic Fibrosis Care Unit, Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | | | - Fabiola De Gregorio
- Regional Cystic Fibrosis Care Unit, Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Antonella Tosco
- Regional Cystic Fibrosis Care Unit, Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Laura Salvadori
- Regional Cystic Fibrosis Care Unit, Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | - Angela Ornella Sepe
- Regional Cystic Fibrosis Care Unit, Department of Translational Medical Sciences, University "Federico II", Naples, Italy
| | | | | | | |
Collapse
|
16
|
Ruf K, Demerath A, Hebestreit H, Kunzmann S. Is sweat testing for cystic fibrosis feasible in patients with down syndrome? BMC Pulm Med 2018; 18:8. [PMID: 29338740 PMCID: PMC5771200 DOI: 10.1186/s12890-018-0580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent airway infections are common in patients with Down’s syndrome (DS). Hence, ruling out Cystic Fibrosis (CF) in these patients is often required. In the past, the value of sweat testing – the gold standard to diagnose CF – has been questioned in DS as false positive results have been reported. However, these reports are based on measurements of sweat osmolality or sodium concentrations, not chloride concentrations. This study analyses sweat secretion rate and chloride concentration in sweat samples of patients with DS in comparison to healthy controls. Methods We assessed sweat samples in 16 patients with DS and 16 healthy controls regarding sweat secretion rate (SSR) and sweat chloride concentration. Results All measured chloride concentrations were within the normal range. The chloride concentrations were slightly, but not significantly lower in patients with DS (15,54 mmol/l (±4,47)) compared to healthy controls (18,31 mmol/l (±10,12)). While no gender gap in chloride concentration could be found, chloride concentration increased with age in both groups. Insufficient sweat was collected in 2 females with DS (12.5% of the study group) but not in an individual of the control group. A significant lower sweat secretion rate was found in the DS group (27,6 μl/30 min (± 12,18)) compared to the control group (42,7 μl/30 min (± 21,22)). In a sub-analysis, female patients produced significantly less sweat (20,8 ± 10,6 μl/30 min) than male patients with DS (36,4 ± 7,8 μl/30 min), which accounts for the difference between patients and controls. Furthermore, while the sweating secretion rate increased with age in the control group, it did not do so in the DS group. Once again this was due to female patients with DS, who did not show a significant increase of sweat secretion rate with age. Conclusions Sweat chloride concentrations were within the normal range in patients with DS and therefore seem to be a reliable tool for testing for CF in these patients. Interestingly, we found a reduced sweat secretion rate in the DS group. Whether the last one has a functional and clinical counterpart, possibly due to a disturbed thermoregulation in DS patients, requires further investigation.
Collapse
Affiliation(s)
- Katharina Ruf
- University Children's Hospital, Würzburg, Germany. .,Children's Hospital of the University of Würzburg, Josef-Schneider Str. 2, 97080, Würzburg, Germany.
| | | | | | - Steffen Kunzmann
- Clinic of Neonatology and Pediatric Intensive Care, Bürgerhospital Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
17
|
Faria AG, Marson FAL, Gomez CCS, Servidoni MDF, Ribeiro AF, Ribeiro JD. Thirty Years of Sweat Chloride Testing at One Referral Center. Front Pediatr 2017; 5:222. [PMID: 29124052 PMCID: PMC5662556 DOI: 10.3389/fped.2017.00222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/03/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To conduct a descriptive analysis of the sweat test (ST), associating ST results with epidemiological data, CFTR (cystic fibrosis transmembrane conductance regulator) mutations and reasons to indicate the ST, as well as correlating sweat sodium and sweat chloride concentrations in subjects. METHODS Retrospective survey and descriptive analysis of 5,721 ST at a university referral center. RESULTS The inclusion of the subjects was based on clinical data related with cystic fibrosis (CF) phenotype. The samples were grouped by (i) sweat chloride concentrations (mEq/L): <30: 3,249/5,277 (61.6%); ≥30 to <60: 1,326/5,277 (25.1%); ≥60: 702/5,277 (13.3%) and (ii) age: (Group A--GA) 0 to <6 months; (Group B--GB) ≥6 months to <18 years; (Group C--GC) ≥18 years. Digestive symptoms showed higher prevalence ratio for the CF diagnosis as well as association between younger age and higher values of sweat chloride, sweat sodium, and chloride/sodium ratio. The indication of ST due to respiratory symptoms was higher in GB and associated with greater age, lower values of sweat chloride, sweat sodium, and chloride/sodium ratio. There was higher prevalence of ST with sweat chloride levels <30 mEq/L in GB, ≥60 mEq/L in GC, and with borderline level in GB. There was positive correlation between sweat sodium and sweat chloride. Sweat chloride/sweat sodium and sweat sodium-sweat chloride indexes showed association with sex, reason for ST indication, and CFTR mutations. Sex alters some values presented in the ST. The number of ST/year performed before and after the newborn screening implementation was the same; however, we observed a higher number of borderlines values. A wide spectrum of CFTR mutation was found. Severe CFTR mutations and F508del/F508del genotype were associated with highest probability of ST chloride levels ≥60 mEq/L, and the absence of CFTR mutations identified was associated with borderline ST and respiratory symptoms. CONCLUSIONS ST data showed wide variability dependent on age, sex, reason for examination indication, CFTR mutations, and weight of the collected sweat sample. Sweat sodium concentration is directly correlated with sweat chloride levels and it could be used as a quality parameter.
Collapse
Affiliation(s)
- Alethéa Guimarães Faria
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Department of Medical Genetics, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Maria de Fátima Servidoni
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - José Dirceu Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, Campinas, Brazil
| |
Collapse
|
18
|
Biological variability of the sweat chloride in diagnostic sweat tests: A retrospective analysis. J Cyst Fibros 2017; 16:30-35. [DOI: 10.1016/j.jcf.2016.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/24/2016] [Accepted: 11/24/2016] [Indexed: 11/18/2022]
|
19
|
Faria AG, Marson FAL, Ribeiro AF, Ribeiro JD. The correlation between age and sweat chloride levels in sweat tests. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 23:227-230. [PMID: 28038996 DOI: 10.1016/j.rppnen.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/08/2016] [Accepted: 11/12/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- A G Faria
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil; Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Brazil
| | - F A L Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil; Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Brazil; Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Brazil.
| | - A F Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil
| | - J D Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Brazil; Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Brazil
| |
Collapse
|
20
|
Collaco JM, Blackman SM, Raraigh KS, Corvol H, Rommens JM, Pace RG, Boelle PY, McGready J, Sosnay PR, Strug LJ, Knowles MR, Cutting GR. Sources of Variation in Sweat Chloride Measurements in Cystic Fibrosis. Am J Respir Crit Care Med 2016; 194:1375-1382. [PMID: 27258095 PMCID: PMC5148144 DOI: 10.1164/rccm.201603-0459oc] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/03/2016] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Expanding the use of cystic fibrosis transmembrane conductance regulator (CFTR) potentiators and correctors for the treatment of cystic fibrosis (CF) requires precise and accurate biomarkers. Sweat chloride concentration provides an in vivo assessment of CFTR function, but it is unknown the degree to which CFTR mutations account for sweat chloride variation. OBJECTIVES To estimate potential sources of variation for sweat chloride measurements, including demographic factors, testing variability, recording biases, and CFTR genotype itself. METHODS A total of 2,639 sweat chloride measurements were obtained in 1,761 twins/siblings from the CF Twin-Sibling Study, French CF Modifier Gene Study, and Canadian Consortium for Genetic Studies. Variance component estimation was performed by nested mixed modeling. MEASUREMENTS AND MAIN RESULTS Across the tested CF population as a whole, CFTR gene mutations were found to be the primary determinant of sweat chloride variability (56.1% of variation) with contributions from variation over time (e.g., factors related to testing on different days; 13.8%), environmental factors (e.g., climate, family diet; 13.5%), other residual factors (e.g., test variability; 9.9%), and unique individual factors (e.g., modifier genes, unique exposures; 6.8%) (likelihood ratio test, P < 0.001). Twin analysis suggested that modifier genes did not play a significant role because the heritability estimate was negligible (H2 = 0; 95% confidence interval, 0.0-0.35). For an individual with CF, variation in sweat chloride was primarily caused by variation over time (58.1%) with the remainder attributable to residual/random factors (41.9%). CONCLUSIONS Variation in the CFTR gene is the predominant cause of sweat chloride variation; most of the non-CFTR variation is caused by testing variability and unique environmental factors. If test precision and accuracy can be improved, sweat chloride measurement could be a valuable biomarker for assessing response to therapies directed at mutant CFTR.
Collapse
Affiliation(s)
| | | | | | - Harriet Corvol
- Assistance Publique-Hôpitaux de Paris, Trousseau Hospital, Paris, France
- Institut National de la Santé et la Recherche Médicale, Paris, France
| | - Johanna M. Rommens
- The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Rhonda G. Pace
- Marsico Lung Institute/Cystic Fibrosis and Pulmonary Diseases Research and Treatment Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Pierre-Yves Boelle
- Institut National de la Santé et la Recherche Médicale, Paris, France
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France; and
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - John McGready
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Lisa J. Strug
- The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Michael R. Knowles
- Marsico Lung Institute/Cystic Fibrosis and Pulmonary Diseases Research and Treatment Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
21
|
Raina MA, Khan MS, Malik SA, Raina AH, Makhdoomi MJ, Bhat JI, Mudassar S. Assessment of Correlation between Sweat Chloride Levels and Clinical Features of Cystic Fibrosis Patients. J Clin Diagn Res 2016; 10:BC01-BC06. [PMID: 28208841 DOI: 10.7860/jcdr/2016/21526.8951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/10/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Cystic Fibrosis (CF) is an autosomal recessive disorder and the incidence of this disease is undermined in Northern India. The distinguishable salty character of the sweat belonging to individuals suffering from CF makes sweat chloride estimation essential for diagnosis of CF disease. AIM The aim of this prospective study was to elucidate the relationship of sweat chloride levels with clinical features and pattern of CF. MATERIALS AND METHODS A total of 182 patients, with clinical features of CF were included in this study for quantitative measurement of sweat chloride. Sweat stimulation and collection involved pilocarpine iontophoresis based on the Gibson and Cooks methodology. The quantitative estimation of chloride was done by Schales and Schales method with some modifications. Cystic Fibrosis Trans Membrane Conductance Regulator (CFTR) mutation status was recorded in case of patients with borderline sweat chloride levels to correlate the results and for follow-up. RESULTS Out of 182 patients having clinical features consistent with CF, borderline and elevated sweat chloride levels were present in 9 (5%) and 41 (22.5%) subjects respectively. Elevated sweat chloride levels were significantly associated with wheeze, Failure To Thrive (FTT), history of CF in Siblings, product of Consanguineous Marriage (CM), digital clubbing and steatorrhoea on univariate analysis. On multivariate analysis only wheeze, FTT and steatorrhoea were found to be significantly associated with elevated sweat chloride levels (p<0.05). Among the nine borderline cases six cases were positive for at least two CFTR mutations and rest of the three cases were not having any mutation in CFTR gene. CONCLUSION The diagnosis is often delayed and the disease is advanced in most patients at the time of diagnosis. Sweat testing is a gold standard for diagnosis of CF patients as genetic mutation profile being heterozygous and unlikely to become diagnostic test.
Collapse
Affiliation(s)
- Manzoor A Raina
- Junior Research Fellow, Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| | - Mosin S Khan
- Senior Resident, Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| | - Showkat A Malik
- PhD Scholar, Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| | - Ab Hameed Raina
- Senior Resident, Department of Internal Medicine, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| | - Mudassir J Makhdoomi
- Junior Research Fellow, Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| | - Javed I Bhat
- Assistant Professor, Department of Paediatrics, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jamu and Kashmir, India
| | - Syed Mudassar
- Professor and Head, Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences , Soura, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
22
|
Faria AG, Marson FAL, Gomez CCDS, Ribeiro MÂGDO, Morais LB, Servidoni MDF, Bertuzzo CS, Sakano E, Goto M, Paschoal IA, Pereira MC, Hessel G, Levy CE, Toro AADC, Peixoto AO, Simões MCR, Lomazi EA, Nogueira RJN, Ribeiro AF, Ribeiro JD. Quality of sweat test (ST) based on the proportion of sweat sodium (Na) and sweat chloride (Cl) as diagnostic parameter of cystic fibrosis: are we on the right way? Diagn Pathol 2016; 11:103. [PMID: 27784314 PMCID: PMC5080702 DOI: 10.1186/s13000-016-0555-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To assess the quality of sweat test (ST) based on the proportion of sweat sodium and sweat chloride as diagnostic parameter of cystic fibrosis (CF). METHODS A retrospective study of 5,721 sweat samples and subsequent descriptive analysis were carried out. The test was considered "of good quality" (correct) when: (i) sweat chloride was lower than 60 mEq/L, and sweat sodium was higher than sweat chloride; (ii) sweat chloride was higher than 60 mEq/L, and sweat sodium was lower than sweat chloride. RESULTS The study included 5,692/5,721 sweat samples of ST which had been requested due to clinical presentations compatible with CF and/or neonatal screenings with altered immunoreactive trypsinogen values. Considering the proportion of sweat sodium and sweat chloride as ST quality parameter, the test was performed correctly in 5,023/5,692 (88.2 %) sweat samples. The sweat chloride test results were grouped into four reference ranges for chloride (i) chloride < 30 mEq/L: 3,651/5,692 (64.1 %); (ii) chloride ≥ 30 mEq/L to < 40 mEq/L: 652/5,692 (11.5 %); (iii) ≥ 40 mEq/L to < 60 mEq/L: 673/5,692 (11.8 %); (iv) ≥ 60 mEq/L: 716/5,692 (12.6 %). In the comparative analysis, there was no association between ST quality and: (i) symptoms to indicate a ST [respiratory (p = 0.084), digestive (p = 0.753), nutritional (p = 0.824), and others (p = 0.136)], (ii) sweat weight (p = 0.416). However, there was a positive association with: (i) gender, (ii) results of ST (p < 0.001), (iii) chloride/sodium ratio (p < 0.001), (iv) subject's age at the time of ST [grouped according to category (p < 0.001) and numerical order (p < 0.001)]. For the subset of 169 patients with CF and two CFTR mutations Class I, II and/or III, in comparative analysis, there was a positive association with: (i) sweat chloride/sodium ratio (p < 0.001), (ii) sweat chloride values (p = 0.047), (iii) subject's age at the time of the ST grouped by numerical order (p = 0.001). CONCLUSIONS Considering that the quality of ST can be assessed by levels of sweat sodium and sweat chloride, an increasing number of low-quality tests could be observed in our sweat samples. The quality of the test was associated with important factors, such as gender, CF diagnosis, and subjects' age.
Collapse
Affiliation(s)
- Alethéa Guimarães Faria
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Tessália Vieira de Camargo, 126, Barão Geraldo, Cidade Universitária Zeferino Vaz, CEP: 13083-887 Campinas, São Paulo Brazil
| | | | - Maria Ângela Gonçalves de Oliveira Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lucas Brioschi Morais
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maria de Fátima Servidoni
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eulália Sakano
- Department of Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Maura Goto
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Ilma Aparecida Paschoal
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Mônica Corso Pereira
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gabriel Hessel
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos Emílio Levy
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | | | | | - José Dirceu Ribeiro
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
- Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| |
Collapse
|
23
|
Glennon T, O'Quigley C, McCaul M, Matzeu G, Beirne S, Wallace GG, Stroiescu F, O'Mahoney N, White P, Diamond D. ‘SWEATCH’: A Wearable Platform for Harvesting and Analysing Sweat Sodium Content. ELECTROANAL 2016. [DOI: 10.1002/elan.201600106] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tom Glennon
- Insight Centre for Data Analytics, National Centre for Sensor Research Dublin City University Dublin 9 Ireland
| | - Conor O'Quigley
- Insight Centre for Data Analytics, National Centre for Sensor Research Dublin City University Dublin 9 Ireland
| | - Margaret McCaul
- Insight Centre for Data Analytics, National Centre for Sensor Research Dublin City University Dublin 9 Ireland
| | - Giusy Matzeu
- Insight Centre for Data Analytics, National Centre for Sensor Research Dublin City University Dublin 9 Ireland
| | - Stephen Beirne
- ARC Centre of Excellence for Electromaterials Science University of Wollongong NSW 2522 Australia
| | - Gordon G. Wallace
- ARC Centre of Excellence for Electromaterials Science University of Wollongong NSW 2522 Australia
| | | | | | - Paddy White
- Shimmer DCU Innovation Campus, Glasnevin Dublin 11 Ireland
| | - Dermot Diamond
- Insight Centre for Data Analytics, National Centre for Sensor Research Dublin City University Dublin 9 Ireland
| |
Collapse
|
24
|
CFTR mutations spectrum and the efficiency of molecular diagnostics in Polish cystic fibrosis patients. PLoS One 2014; 9:e89094. [PMID: 24586523 PMCID: PMC3935850 DOI: 10.1371/journal.pone.0089094] [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: 09/14/2013] [Accepted: 01/15/2014] [Indexed: 01/20/2023] Open
Abstract
Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane regulator gene (CFTR). In light of the strong allelic heterogeneity and regional specificity of the mutation spectrum, the strategy of molecular diagnostics and counseling in CF requires genetic tests to reflect the frequency profile characteristic for a given population. The goal of the study was to provide an updated comprehensive estimation of the distribution of CFTR mutations in Polish CF patients and to assess the effectiveness of INNOLiPA_CFTR tests in Polish population. The analyzed cohort consisted of 738 patients with the clinically confirmed CF diagnosis, prescreened for molecular defects using INNOLiPA_CFTR panels from Innogenetics. A combined efficiency of INNOLiPA CFTR_19 and CFTR_17_TnUpdate tests was 75.5%; both mutations were detected in 68.2%, and one mutation in 14.8% of the affected individuals. The group composed of all the patients with only one or with no mutation detected (109 and 126 individuals, respectively) was analyzed further using a mutation screening approach, i.e. SSCP/HD (single strand conformational polymorphism/heteroduplex) analysis of PCR products followed by sequencing of the coding sequence. As a result, 53 more mutations were found in 97 patients. The overall efficiency of the CF allele detection was 82.5% (7.0% increase compared to INNOLiPA tests alone). The distribution of the most frequent mutations in Poland was assessed. Most of the mutations repetitively found in Polish patients had been previously described in other European populations. The most frequent mutated allele, F508del, represented 54.5% of Polish CF chromosomes. Another eight mutations had frequencies over 1%, 24 had frequencies between 1 and 0.1%; c.2052-2053insA and c.3468+2_3468+3insT were the most frequent non-INNOLiPA mutations. Mutation distribution described herein is also relevant to the Polish diaspora. Our study also demonstrates that the reported efficiency of mutation detection strongly depends on the diagnostic experience of referring health centers.
Collapse
|