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Schnabel-Besson E, Mütze U, Dikow N, Hörster F, Morath MA, Alex K, Brennenstuhl H, Settegast S, Okun JG, Schaaf CP, Winkler EC, Kölker S. Wilson and Jungner Revisited: Are Screening Criteria Fit for the 21st Century? Int J Neonatal Screen 2024; 10:62. [PMID: 39311364 PMCID: PMC11417796 DOI: 10.3390/ijns10030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/29/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024] Open
Abstract
Driven by technological innovations, newborn screening (NBS) panels have been expanded and the development of genomic NBS pilot programs is rapidly progressing. Decisions on disease selection for NBS are still based on the Wilson and Jungner (WJ) criteria published in 1968. Despite this uniform reference, interpretation of the WJ criteria and actual disease selection for NBS programs are highly variable. A systematic literature search [PubMED search "Wilson" AND "Jungner"; last search 16.07.22] was performed to evaluate the applicability of the WJ criteria for current and future NBS programs and the need for adaptation. By at least two reviewers, 105 publications (systematic literature search, N = 77; manual search, N = 28) were screened for relevant content and, finally, 38 publications were evaluated. Limited by the study design of qualitative text analysis, no statistical evaluation was performed, but a structured collection of reported aspects of criticism and proposed improvements was instead collated. This revealed a set of general limitations of the WJ criteria, such as imprecise terminology, lack of measurability and objectivity, missing pediatric focus, and absent guidance on program management. Furthermore, it unraveled specific aspects of criticism on clinical, diagnostic, therapeutic, and economical aspects. A major obstacle was found to be the incompletely understood natural history and phenotypic diversity of rare diseases prior to NBS implementation, resulting in uncertainty about case definition, risk stratification, and indications for treatment. This gap could be closed through the systematic collection and evaluation of real-world evidence on the quality, safety, and (cost-)effectiveness of NBS, as well as the long-term benefits experienced by screened individuals. An integrated NBS public health program that is designed to continuously learn would fulfil these requirements, and a multi-dimensional framework for future NBS programs integrating medical, ethical, legal, and societal perspectives is overdue.
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Affiliation(s)
- Elena Schnabel-Besson
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Ulrike Mütze
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Friederike Hörster
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Marina A. Morath
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Karla Alex
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Heiko Brennenstuhl
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Sascha Settegast
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Jürgen G. Okun
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Christian P. Schaaf
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Eva C. Winkler
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
| | - Stefan Kölker
- Division of Pediatric Neurology and Metabolic Medicine, Department of Pediatrics I, Medical Faculty of Heidelberg, Heidelberg University, 69120 Heidelberg, Germany
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Yan T, Weng F, Ming Y, Zhu S, Zhu M, Wang C, Guo C, Zhu K. Luminescence Probes in Bio-Applications: From Principle to Practice. BIOSENSORS 2024; 14:333. [PMID: 39056609 PMCID: PMC11274413 DOI: 10.3390/bios14070333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
Bioanalysis based on optical imaging has gained significant progress in the last few decades. Luminescence probes are capable of detecting, monitoring, and tracing particular biomolecules in complex biological systems to figure out the roles of these molecules in organisms. Considering the rapid development of luminescence probes for bio-applications and their promising future, we have attempted to explore the working principles and recent advances in bio-applications of luminescence probes, in the hope of helping readers gain a detailed understanding of luminescence probes developed in recent years. In this review, we first focus on the current widely used luminescence probes, including fluorescence probes, bioluminescence probes, chemiluminescence probes, afterglow probes, photoacoustic probes, and Cerenkov luminescence probes. The working principles for each type of luminescence probe are concisely described and the bio-application of the luminescence probes is summarized by category, including metal ions detection, secretion detection, imaging, and therapy.
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Affiliation(s)
| | | | | | | | | | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China; (T.Y.); (F.W.); (Y.M.); (S.Z.); (M.Z.)
| | - Changfa Guo
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China; (T.Y.); (F.W.); (Y.M.); (S.Z.); (M.Z.)
| | - Kai Zhu
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University, Shanghai 200032, China; (T.Y.); (F.W.); (Y.M.); (S.Z.); (M.Z.)
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Min J, Tu J, Xu C, Lukas H, Shin S, Yang Y, Solomon SA, Mukasa D, Gao W. Skin-Interfaced Wearable Sweat Sensors for Precision Medicine. Chem Rev 2023; 123:5049-5138. [PMID: 36971504 PMCID: PMC10406569 DOI: 10.1021/acs.chemrev.2c00823] [Citation(s) in RCA: 106] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Wearable sensors hold great potential in empowering personalized health monitoring, predictive analytics, and timely intervention toward personalized healthcare. Advances in flexible electronics, materials science, and electrochemistry have spurred the development of wearable sweat sensors that enable the continuous and noninvasive screening of analytes indicative of health status. Existing major challenges in wearable sensors include: improving the sweat extraction and sweat sensing capabilities, improving the form factor of the wearable device for minimal discomfort and reliable measurements when worn, and understanding the clinical value of sweat analytes toward biomarker discovery. This review provides a comprehensive review of wearable sweat sensors and outlines state-of-the-art technologies and research that strive to bridge these gaps. The physiology of sweat, materials, biosensing mechanisms and advances, and approaches for sweat induction and sampling are introduced. Additionally, design considerations for the system-level development of wearable sweat sensing devices, spanning from strategies for prolonged sweat extraction to efficient powering of wearables, are discussed. Furthermore, the applications, data analytics, commercialization efforts, challenges, and prospects of wearable sweat sensors for precision medicine are discussed.
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Affiliation(s)
- Jihong Min
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Jiaobing Tu
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Changhao Xu
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Heather Lukas
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Soyoung Shin
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Yiran Yang
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Samuel A. Solomon
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Daniel Mukasa
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California, 91125, USA
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Patel P, Yeley J, Brown C, Wesson M, Lesko BG, Slaven JE, Chmiel JF, Jain R, Sanders DB. Immunoreactive Trypsinogen in Infants Born to Women with Cystic Fibrosis Taking Elexacaftor–Tezacaftor–Ivacaftor. Int J Neonatal Screen 2023; 9:ijns9010010. [PMID: 36975847 PMCID: PMC10056483 DOI: 10.3390/ijns9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Most people with cystic fibrosis (CF) are diagnosed following abnormal newborn screening (NBS), which begins with measurement of immunoreactive trypsinogen (IRT) values. A case report found low concentrations of IRT in an infant with CF exposed to the CF transmembrane conductance regulator (CFTR) modulator, elexacaftor–tezacaftor–ivacaftor (ETI), in utero. However, IRT values in infants born to mothers taking ETI have not been systematically assessed. We hypothesized that ETI-exposed infants have lower IRT values than newborns with CF, CFTR-related metabolic syndrome/CF screen positive, inconclusive diagnosis (CRMS/CFSPID), or CF carriers. IRT values were collected from infants born in Indiana between 1 January 2020, and 2 June 2022, with ≥1 CFTR mutation. IRT values were compared to infants born to mothers with CF taking ETI followed at our institution. Compared to infants identified with CF (n = 51), CRMS/CFSPID (n = 21), and CF carriers (n = 489), ETI-exposed infants (n = 19) had lower IRT values (p < 0.001). Infants with normal NBS results for CF had similar median (interquartile range) IRT values, 22.5 (16.8, 30.6) ng/mL, as ETI-exposed infants, 18.9 (15.2, 26.5). IRT values from ETI-exposed infants were lower than for infants with abnormal NBS for CF. We recommend that NBS programs consider performing CFTR variant analysis for all ETI-exposed infants.
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Affiliation(s)
- Payal Patel
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jana Yeley
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Cynthia Brown
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Melissa Wesson
- Department of Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Barbara G. Lesko
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - James E. Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - James F. Chmiel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Don B. Sanders
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Correspondence:
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Martiniano SL, Croak K, Bonn G, Sontag MK, Sagel SD. Improving outcomes for Colorado's IRT-IRT-DNA cystic fibrosis newborn screening algorithm by implementing floating cutoffs. Mol Genet Metab 2021; 134:65-67. [PMID: 34489170 DOI: 10.1016/j.ymgme.2021.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
The Colorado Newborn Screening Program (CO-NBS) screens for cystic fibrosis (CF) by measuring immunoreactive trypsinogen (IRT) from two screens coupled with DNA analysis (IRT/IRT/DNA). The Colorado CF Care Center identified 8 missed CF cases among 358,187 infants screened by the CO-NSP since 2016. Retrospective analysis of CO-NSP IRT data shows that a 96th percentile floating IRT cutoff with a 50 ng/mL fixed cutoff on the first screen, and second screen 50 ng/mL fixed cutoff would have identified 7 of the 8 missed cases. These efforts demonstrate the importance of continuous quality improvement in order to increase sensitivity and reduce missed cases.
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Affiliation(s)
- Stacey L Martiniano
- University of Colorado Anschutz Medical Center, United States; Children's Hospital Colorado, United States.
| | - Kendra Croak
- Colorado Department of Public Health & Environment, United States
| | - Gregory Bonn
- Colorado Department of Public Health & Environment, United States
| | - Marci K Sontag
- Center for Public Health Innovation at CI International, United States
| | - Scott D Sagel
- University of Colorado Anschutz Medical Center, United States; Children's Hospital Colorado, United States
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Ray TR, Ivanovic M, Curtis PM, Franklin D, Guventurk K, Jeang WJ, Chafetz J, Gaertner H, Young G, Rebollo S, Model JB, Lee SP, Ciraldo J, Reeder JT, Hourlier-Fargette A, Bandodkar AJ, Choi J, Aranyosi AJ, Ghaffari R, McColley SA, Haymond S, Rogers JA. Soft, skin-interfaced sweat stickers for cystic fibrosis diagnosis and management. Sci Transl Med 2021; 13:eabd8109. [PMID: 33790027 PMCID: PMC8351625 DOI: 10.1126/scitranslmed.abd8109] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
The concentration of chloride in sweat remains the most robust biomarker for confirmatory diagnosis of cystic fibrosis (CF), a common life-shortening genetic disorder. Early diagnosis via quantitative assessment of sweat chloride allows prompt initiation of care and is critically important to extend life expectancy and improve quality of life. The collection and analysis of sweat using conventional wrist-strapped devices and iontophoresis can be cumbersome, particularly for infants with fragile skin, who often have insufficient sweat production. Here, we introduce a soft, epidermal microfluidic device ("sweat sticker") designed for the simple and rapid collection and analysis of sweat. Intimate, conformal coupling with the skin supports nearly perfect efficiency in sweat collection without leakage. Real-time image analysis of chloride reagents allows for quantitative assessment of chloride concentrations using a smartphone camera, without requiring extraction of sweat or external analysis. Clinical validation studies involving patients with CF and healthy subjects, across a spectrum of age groups, support clinical equivalence compared to existing device platforms in terms of accuracy and demonstrate meaningful reductions in rates of leakage. The wearable microfluidic technologies and smartphone-based analytics reported here establish the foundation for diagnosis of CF outside of clinical settings.
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Affiliation(s)
- Tyler R Ray
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, HI 96822, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Maja Ivanovic
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Paul M Curtis
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Daniel Franklin
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Kerem Guventurk
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
| | - William J Jeang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Joseph Chafetz
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Hannah Gaertner
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Grace Young
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
| | - Steve Rebollo
- Pritzker School of Molecular Engineering and Department of Physics, University of Chicago, Chicago, IL 60637, USA
| | - Jeffrey B Model
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Stephen P Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - John Ciraldo
- Micro/Nano Fabrication Facility (NUFAB) Northwestern University, Evanston, IL 60202, USA
| | - Jonathan T Reeder
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
| | - Aurélie Hourlier-Fargette
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Université de Strasbourg, CNRS, Institut Charles Sadron UPR22, F-67000, Strasbourg 67034, France
| | - Amay J Bandodkar
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
| | - Jungil Choi
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- School of Mechanical Engineering, Kookmin University, Seoul 02707, Republic of Korea
| | - Alexander J Aranyosi
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Shannon Haymond
- Department of Pathology, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60202, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60202, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60202, USA
- Epicore Biosystems Inc., Cambridge, MA 02139, USA
- Department of Mechanical Engineering, Department of Electrical and Computer Engineering, Department of Chemistry, Northwestern University, Evanston, IL 60202, USA
- Department of Neurological Surgery Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Clinical and Genotypical Features of False-Negative Patients in 26 Years of Cystic Fibrosis Neonatal Screening in Tuscany, Italy. Diagnostics (Basel) 2020; 10:diagnostics10070446. [PMID: 32630227 PMCID: PMC7399885 DOI: 10.3390/diagnostics10070446] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022] Open
Abstract
Cystic fibrosis (CF) is a life-threatening and common genetic disorder. Cystic fibrosis newborn screening (CF NBS) has been implemented in many countries over the last 30 years, becoming a widely accepted public health strategy in economically developed countries. False-negative (FN) cases can occur after CF NBS, with the number depending on the method. We evaluated the delayed diagnosis of CF, identifying the patients who had false-negative CF NBS results over 26 years (1992–2018) in Tuscany, Italy. The introduction of DNA analysis to the newborn screening protocol improved the sensitivity of the test and reduced the FNs. Our experience showed that, overall, at least 8.7% of cases of CF received FNs (18 cases) and were diagnosed later, with an average age of 6.6 years (range: 4 months to 22 years). Respiratory symptoms and salt-loss syndrome (metabolic hypochloremic alkalosis) are suggestive symptoms of CF and were commons events in FN patients. In Tuscany, a region with a high CFTR allelic heterogeneity, the salt-loss syndrome was a common event in FNs. Therefore, we provided evidence to support the claim that the FN patients had CFTR mutations rarer compared with the true-positive cases. We underline the importance of vigilance toward clinical manifestations suggestive of CF on the part of the primary care providers and hospital physicians in a region with an efficient newborn screening program.
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Marcão A, Barreto C, Pereira L, Vaz LG, Cavaco J, Casimiro A, Félix M, Silva TR, Barbosa T, Freitas C, Nunes S, Felício V, Lopes L, Amaral M, Vilarinho L. Cystic Fibrosis Newborn Screening in Portugal: PAP Value in Populations with Stringent Rules for Genetic Studies. Int J Neonatal Screen 2018; 4:22. [PMID: 33072945 PMCID: PMC7548908 DOI: 10.3390/ijns4030022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022] Open
Abstract
Newborn screening (NBS) for cystic fibrosis (CF) has been shown to be advantageous for children with CF, and has thus been included in most NBS programs using various algorithms. With this study, we intend to establish the most appropriate algorithm for CF-NBS in the Portuguese population, to determine the incidence, and to contribute to elucidating the genetic epidemiology of CF in Portugal. This was a nationwide three-year pilot study including 255,000 newborns (NB) that were also screened for congenital hypothyroidism (CH) and 24 other metabolic disorders included in the Portuguese screening program. Most samples were collected in local health centers spread all over the country, between the 3rd and 6th days of life. The algorithm tested includes immunoreactive trypsinogen (IRT) determination, pancreatitis associated protein (PAP) as a second tier, and genetic study for cases referred to specialized clinical centers. Thirty-four CF cases were confirmed positive, thus indicating an incidence of 1:7500 NB. The p.F508del mutation was found in 79% of the alleles. According to the results presented here, CF-NBS is recommended to be included in the Portuguese NBS panel with a small adjustment regarding the PAP cut-off, which we expect to contribute to the improvement of the CF-NBS performance. According to our results, this algorithm is a valuable alternative for CF-NBS in populations with stringent rules for genetic studies.
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Affiliation(s)
- Ana Marcão
- National Institute of Health Dr Ricardo Jorge, Human Genetics Department, Newborn Screening, Metabolism and Genetic Unit, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
| | - Celeste Barreto
- Cystic Fibrosis Center, Department of Pediatrics, Hospital de Santa Maria (CHLN), Lisbon Academic Medical Center, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Correspondence: (C.B.); (L.V.); Tel.: +351-22-3401171 (L.V.)
| | - Luísa Pereira
- Cystic Fibrosis Center, Department of Pediatrics, Hospital de Santa Maria (CHLN), Lisbon Academic Medical Center, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luísa Guedes Vaz
- Cystic Fibrosis Center, Department of Pediatrics, Centro Hospitalar S. João, Alameda do Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Cavaco
- Cystic Fibrosis Center, Centro Hospitalar de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
| | - Ana Casimiro
- Cystic Fibrosis Center, Centro Hospitalar de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
| | - Miguel Félix
- Cystic Fibrosis Center, Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Rua Doutor Afonso Romão 3030, 3000-609 Coimbra, Portugal
| | - Teresa Reis Silva
- Cystic Fibrosis Center, Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Rua Doutor Afonso Romão 3030, 3000-609 Coimbra, Portugal
| | - Telma Barbosa
- Cystic Fibrosis Center, Department of Pediatrics, Centro Hospitalar do Porto, Largo da Maternidade de Júlio Dinis 4050-651, Porto, Portugal
| | - Cristina Freitas
- Department of Pediatrics, Funchal Central Hospital, Avenida Luís de Camões 57, 9004-514 Funchal, Portugal
| | - Sidónia Nunes
- Department of Pediatrics, Funchal Central Hospital, Avenida Luís de Camões 57, 9004-514 Funchal, Portugal
| | - Verónica Felício
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Campo Grande, C8, 1749-016 Lisboa, Portugal
| | - Lurdes Lopes
- National Institute of Health Dr Ricardo Jorge, Human Genetics Department, Newborn Screening, Metabolism and Genetic Unit, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
| | - Margarida Amaral
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisboa, Campo Grande, C8, 1749-016 Lisboa, Portugal
| | - Laura Vilarinho
- National Institute of Health Dr Ricardo Jorge, Human Genetics Department, Newborn Screening, Metabolism and Genetic Unit, Rua Alexandre Herculano 321, 4000-055 Porto, Portugal
- Correspondence: (C.B.); (L.V.); Tel.: +351-22-3401171 (L.V.)
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Munck A, Delmas D, Audrézet MP, Lemonnier L, Cheillan D, Roussey M. Optimization of the French cystic fibrosis newborn screening programme by a centralized tracking process. J Med Screen 2017; 25:6-12. [PMID: 28454512 PMCID: PMC5813881 DOI: 10.1177/0969141317692611] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives To evaluate the French cystic fibrosis newborn screening algorithm, based on data tracked by a centralized monitoring process, from 2002 to 2014. The programme aimed to attain European Standards in terms of positive predictive value, sensitivity, the ratio of screen positive patients diagnosed with cystic fibrosis to infants who screen positive but with inconclusive diagnosis (CFSPID), and time to diagnosis. Methods Retrospective analysis of programme performance, compliance with the algorithm, and changes in screening strategy. Results Modifications in the flow chart protocol improved the positive predictive value to 0.31 while maintaining the sensitivity at 0.95. Among infants diagnosed with cystic fibrosis, or identified as CFSPID, sweat test results were obtained for 94%, and two mutations were identified after exhaustive screening for the gene, when applicable, in 99.6%. The rate of pending diagnosis was very low (0.5%). The ratio of infants with cystic fibrosis:CFSPID was 6.3:1. Age at initial visit at the CF centre was ≤ 35 days, respectively, in 53%/26%. Conclusion Performances were in agreement with European standards, but timeliness of initial visit needed improvement. Our data complement an accumulating body of evidence demonstrating that attention must be paid to such ethical considerations as limiting carrier detection and inconclusive diagnosis. Newborn screening programmes should have a rigorous centralized monitoring process to warrant adjustments for improving performance to attain consensus guidelines.
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Affiliation(s)
- Anne Munck
- 1 Association Française pour le Dépistage et la Prévention des Handicaps de l' Enfant (AFDPHE), Paris, France.,2 Hôpital Robert Debré Assistante publique-Hôpitaux de Paris, Université Paris 7, CF Centre, Paris, France
| | - Dominique Delmas
- 1 Association Française pour le Dépistage et la Prévention des Handicaps de l' Enfant (AFDPHE), Paris, France
| | - Marie-Pierre Audrézet
- 1 Association Française pour le Dépistage et la Prévention des Handicaps de l' Enfant (AFDPHE), Paris, France.,3 Laboratoire de Génétique Moléculaire, CHRU, Brest, France
| | | | - David Cheillan
- 1 Association Française pour le Dépistage et la Prévention des Handicaps de l' Enfant (AFDPHE), Paris, France.,5 Hospices Civils de Lyon, Service des Maladies héréditaires du Métabolisme et Dépistage néonatal, INSERM U 1060, Lyon, France
| | - Michel Roussey
- 1 Association Française pour le Dépistage et la Prévention des Handicaps de l' Enfant (AFDPHE), Paris, France
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Farrell PM, White TB, Howenstine MS, Munck A, Parad RB, Rosenfeld M, Sommerburg O, Accurso FJ, Davies JC, Rock MJ, Sanders DB, Wilschanski M, Sermet-Gaudelus I, Blau H, Gartner S, McColley SA. Diagnosis of Cystic Fibrosis in Screened Populations. J Pediatr 2017; 181S:S33-S44.e2. [PMID: 28129810 DOI: 10.1016/j.jpeds.2016.09.065] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cystic fibrosis (CF) can be difficult to diagnose, even when newborn screening (NBS) tests yield positive results. This challenge is exacerbated by the multitude of NBS protocols, misunderstandings about screening vs diagnostic tests, and the lack of guidelines for presumptive diagnoses. There is also confusion regarding the designation of age at diagnosis. STUDY DESIGN To improve diagnosis and achieve standardization in definitions worldwide, the CF Foundation convened a committee of 32 experts with a mission to develop clear and actionable consensus guidelines on diagnosis of CF with an emphasis on screened populations, especially the newborn population. A comprehensive literature review was performed with emphasis on relevant articles published during the past decade. RESULTS After reviewing the common screening protocols and outcome scenarios, 14 of 27 consensus statements were drafted that apply to screened populations. These were approved by 80% or more of the participants. CONCLUSIONS It is recommended that all diagnoses be established by demonstrating dysfunction of the CF transmembrane conductance regulator (CFTR) channel, initially with a sweat chloride test and, when needed, potentially with newer methods assessing membrane transport directly, such as intestinal current measurements. Even in babies with 2 CF-causing mutations detected via NBS, diagnosis must be confirmed by demonstrating CFTR dysfunction. The committee also recommends that the latest classifications identified in the Clinical and Functional Translation of CFTR project [http://www.cftr2.org/index.php] should be used to aid with CF diagnosis. Finally, to avoid delays in treatment, we provide guidelines for presumptive diagnoses and recommend how to determine the age of diagnosis.
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Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle S Howenstine
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Anne Munck
- Centres de Ressources et de Compétences pour la Mucoviscidose, Hôpital Robert Debre, Paris, France
| | - Richard B Parad
- Department of Pediatric and Newborn Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | | | - Frank J Accurso
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Jane C Davies
- Pediatric Respirology and Experimental Medicine, Imperial College London and Pediatric Respiratory Medicine, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Michael J Rock
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Don B Sanders
- Department of Pediatrics, Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Wilschanski
- Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Sermet-Gaudelus
- Institut Necker Enfants Malades/INSERM U1151, Hôpital Necker Enfants Malades, Centres de Ressources et de Compétences pour la Mucoviscidose, Paris, France
| | - Hannah Blau
- Sackler Faculty of Medicine, Graub Cystic Fibrosis Center, Pulmonary Institute Schneider Children's Medical Center of Israel, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | | | - Susanna A McColley
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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Farrell PM, White TB, Derichs N, Castellani C, Rosenstein BJ. Cystic Fibrosis Diagnostic Challenges over 4 Decades: Historical Perspectives and Lessons Learned. J Pediatr 2017; 181S:S16-S26. [PMID: 28129808 DOI: 10.1016/j.jpeds.2016.09.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Because cystic fibrosis (CF) can be difficult to diagnose, and because information about the genetic complexities and pathologic basis of the disease has grown so rapidly over the decades, several consensus conferences have been held by the US CF Foundation, and a variety of other efforts to improve diagnostic practices have been organized by the European CF Society. Despite these efforts, the application of diagnostic criteria has been variable and caused confusion. STUDY DESIGN To improve diagnosis and achieve standardization in terms and definitions worldwide, the CF Foundation in 2015 convened a committee of 32 experts in the diagnosis of CF from 9 countries. As part of the process, all previous consensus-seeking exercises sponsored by the CF Foundation, along with the important efforts of the European CF Society, were comprehensively and critically reviewed. The goal was to better understand why consensus conferences and their publications have not led to the desired results. RESULTS Lessons learned from previous diagnosis consensus processes and products were identified. It was decided that participation in developing a consensus was generally not inclusive enough for global impact. It was also found that many efforts to address sweat test issues were valuable but did not always improve clinical practices as CF diagnostic testing evolved. It also became clear from this review that premature applications of potential diagnostic tests such as nasal potential difference and intestinal current measurement should be avoided until validation and standardization occur. Finally, we have learned that due to the significant and growing number of cases that are challenging to diagnose, an associated continuing medical education program is both desirable and necessary. CONCLUSIONS It is necessary but not sufficient to organize and publish CF diagnosis consensus processes. Follow-up implementation efforts and monitoring practices seem essential.
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Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Nico Derichs
- CFTR Biomarker Center and Translational CF Research Group, CF Center, Pediatric Pulmonology and Immunology , Charité Universitätsmedizin Berlin, Berlin, Germany
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Farrell PM, White TB. Introduction to "Cystic Fibrosis Foundation Consensus Guidelines for Diagnosis of Cystic Fibrosis". J Pediatr 2017; 181S:S1-S3. [PMID: 28129807 DOI: 10.1016/j.jpeds.2016.09.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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13
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Massie J. Newborn screening and population carrier screening for cystic fibrosis: Two ends of the same rope. J Cyst Fibros 2016; 15:407-8. [PMID: 27261366 DOI: 10.1016/j.jcf.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Australia; Department of Paediatrics, University of Melbourne, Australia; Infection, Immunity, Environment Theme, Murdoch Children's Research Institute, Australia; Children's Bioethics Centre, Royal Children's Hospital, Australia.
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