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Meneses DG, Dos Santos FR, Botelho AJ, Bispo LM, Matos CG, Propheta VGS, Rodrigues AF, Oliveira GU, da Silva AM, Gurgel RQ. Diagnosis of cystic fibrosis: a high heterogeneity of symptoms and genotypes in a Brazil population. BMC Pediatr 2024; 24:422. [PMID: 38956483 PMCID: PMC11218259 DOI: 10.1186/s12887-024-04891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION In highly multiracial populations with inadequate newborn screening, knowledge of the various phenotypic presentations of Cystic Fibrosis (CF) can help reach an early diagnosis. This study aims to describe phenotypes and genotypes at the time of CF diagnosis in a state in the Northeast Region of Brazil. METHODS Retrospective cross-sectional study. Clinical data were extracted from the medical records of CF patients. Clinical, laboratory, and genotypic characteristics were described for patients admitted to a tertiary referral center between 2007 and 2021. RESULTS Fifty-eight (58) patients were included in the study, 53.5% of whom were diagnosed through clinical suspicion. The median age at diagnosis was 4.7 months (IQR: 1.5-14.8 months). Five patients had false-negative results in the newborn screening. Faltering growth was the most frequent clinical manifestation. Bronchiectasis and a history of pneumonia predominated in those older than ten, while thinness, underweight, and electrolyte imbalances were more frequent in children under two. Sequencing of the CFTR gene identified 27 genotypes, with at least one class I-III variant in all patients, and nine variants that are rare, previously undescribed, or have uncertain significance (619delA, T12991, K162Q, 3195del6, 1678del > T, 124del123bp, 3121-3113 A > T). The most frequent alleles were p.Phe508del, p.Gly542*, p.Arg334Trp, and p.Ser549Arg. CONCLUSIONS Malnutrition and electrolyte imbalances were the most frequent phenotypes for children < 2 years and were associated with genotypes including 2 class I-III variants. Rare and previously undescribed variants were identified. The p.Gly542*, p.Arg334Trp, and p.Ser549Arg alleles were among the most frequent variants in this population.
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Affiliation(s)
- Daniela Gois Meneses
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil.
| | - Fábia Regina Dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Anne Jardim Botelho
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Luciana Mota Bispo
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Camilla Guerra Matos
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Vynicius Goltran Sobral Propheta
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Alexia Ferreira Rodrigues
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Géssica Uruga Oliveira
- Center for Biological and Health Sciences (NPGME), University Hospital, Federal University of Sergipe, Rua Cláudio Batista 505, Palestina, Aracaju, Sergipe, CEP 49060-025, Brazil
| | - Angela Maria da Silva
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Ricardo Queiroz Gurgel
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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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.
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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;
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Díez Rodríguez GR, Figueredo Lago JE, Armas Cayarga A, González González YJ, García de la Rosa I, Collazo Mesa T, López Reyes I, Batista Lozada Y, Rodríguez Calá FR, García Sánchez JB. A novel high-resolution melting analysis strategy for detecting cystic fibrosis-causing variants. Lab Med 2024; 55:185-197. [PMID: 37417450 DOI: 10.1093/labmed/lmad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Cystic fibrosis (CF), an autosomal recessive disease, is caused by variants in both alleles of the CF transmembrane conductance regulator (CFTR) gene. A new assay based on allele-specific polymerase chain reaction and high-resolution melting analysis was developed for the detection of 18 CF-causing CFTR variants previously identified in Cuba and Latin America. The assay is also useful for zygosity determination of mutated alleles and includes internal controls. The reaction mixtures were normalized and evaluated using blood samples collected on filter paper. The evaluation of analytical parameters demonstrated the specificity and sensitivity of the method to detect the included CFTR variants. Internal and external validations yielded a 100% agreement between the new assay and the used reference tests. This assay can complement CF newborn screening not only in Cuba but also in Latin America.
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Affiliation(s)
| | | | | | | | | | - Teresa Collazo Mesa
- National Center of Medical Genetics, Medical University of Havana, Playa, Havana, Cuba
| | - Ixchel López Reyes
- National Center of Medical Genetics, Medical University of Havana, Playa, Havana, Cuba
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Lazareva TE, Barbitoff YA, Nasykhova YA, Pavlova NS, Bogaychuk PM, Glotov AS. Statistical Dissection of the Genetic Determinants of Phenotypic Heterogeneity in Genes with Multiple Associated Rare Diseases. Genes (Basel) 2023; 14:2100. [PMID: 38003043 PMCID: PMC10671084 DOI: 10.3390/genes14112100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Phenotypicheterogeneity is a phenomenon in which distinct phenotypes can develop in individuals bearing pathogenic variants in the same gene. Genetic factors, gene interactions, and environmental factors are usually considered the key mechanisms of this phenomenon. Phenotypic heterogeneity may impact the prognosis of the disease severity and symptoms. In our work, we used publicly available data on the association between genetic variants and Mendelian disease to investigate the genetic factors (such as the intragenic localization and type of a variant) driving the heterogeneity of gene-disease relationships. First, we showed that genes linked to multiple rare diseases (GMDs) are more constrained and tend to encode more transcripts with high levels of expression across tissues. Next, we assessed the role of variant localization and variant types in specifying the exact phenotype for GMD variants. We discovered that none of these factors is sufficient to explain the phenomenon of such heterogeneous gene-disease relationships. In total, we identified only 38 genes with a weak trend towards significant differences in variant localization and 30 genes with nominal significant differences in variant type for the two associated disorders. Remarkably, four of these genes showed significant differences in both tests. At the same time, our analysis suggests that variant localization and type are more important for genes linked to autosomal dominant disease. Taken together, our results emphasize the gene-level factors dissecting distinct Mendelian diseases linked to one common gene based on open-access genetic data and highlight the importance of exploring other factors that contributed to phenotypic heterogeneity.
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Affiliation(s)
- Tatyana E. Lazareva
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, 199034 St. Petersburg, Russia; (T.E.L.); (Y.A.N.)
| | - Yury A. Barbitoff
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, 199034 St. Petersburg, Russia; (T.E.L.); (Y.A.N.)
- Bioinformatics Institute, Kantemirovskaya St. 2A, 197342 St. Petersburg, Russia; (N.S.P.); (P.M.B.)
| | - Yulia A. Nasykhova
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, 199034 St. Petersburg, Russia; (T.E.L.); (Y.A.N.)
| | - Nadezhda S. Pavlova
- Bioinformatics Institute, Kantemirovskaya St. 2A, 197342 St. Petersburg, Russia; (N.S.P.); (P.M.B.)
| | - Polina M. Bogaychuk
- Bioinformatics Institute, Kantemirovskaya St. 2A, 197342 St. Petersburg, Russia; (N.S.P.); (P.M.B.)
| | - Andrey S. Glotov
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, 199034 St. Petersburg, Russia; (T.E.L.); (Y.A.N.)
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5
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Myer H, Chupita S, Jnah A. Cystic Fibrosis: Back to the Basics. Neonatal Netw 2023; 42:23-30. [PMID: 36631257 DOI: 10.1891/nn-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 01/13/2023]
Abstract
Cystic fibrosis (CF) is the most common genetic disorder in Caucasian individuals, with an incidence of 1/2,500-3,500 live births. When CF was first described in 1938, most children died in infancy. Currently, the average lifespan is 28-47.7 years. Although new breakthroughs have occurred, CF is still incurable. Both early diagnosis and treatment by multidisciplinary teams are essential to optimize short- and long-term outcomes. It is imperative for neonatal clinicians to keep up to date on the most current research, treatment, and management of CF to provide the best outcomes. This article offers clinicians an updated review of the pathophysiology and clinical manifestations of CF, as well as current evidence-based diagnostics and treatment regimens.
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6
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Moshirfar M, Brown AH, Sulit CA, Corbin WM, Ronquillo YC, Hoopes PC. Corneal Refractive Surgery Considerations in Patients with Cystic Fibrosis and Cystic Fibrosis Transmembrane Conductance Regulator-Related Disorders. Int Med Case Rep J 2022; 15:647-656. [PMID: 36388243 PMCID: PMC9656410 DOI: 10.2147/imcrj.s381078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
This article discusses common ocular manifestations of cystic fibrosis (CF) and cystic fibrosis transmembrane conductance regulator-related disorders (CFTR-RD). A structured approach for assessing and treating patients with CF/CFTR-RD seeking corneal refractive surgery is proposed, as well as a novel surgical risk scoring system. We also report two patients with various manifestations of CFTR dysfunction who presented for refractive surgery and the outcomes of the procedures. Surgeons seeking to perform refractive surgery on patients with CF/CFTR-RD should be aware of mild to severe clinical manifestations of CFTR dysfunction. Specific systemic and ocular manifestations of CF include chronic obstructive pulmonary disease (COPD), bronchiectasis, recurrent pulmonary infections, CF-related diabetes and liver disease, pancreatic insufficiency, conjunctival xerosis, night blindness, meibomian gland dysfunction (MGD), and blepharitis. Corneal manifestations include dry eye disease (DED), punctate keratitis (PK), filamentary keratitis (FK), xerophthalmia, and decreased endothelial cell density and central corneal thickness. Utilization of the appropriate review of systems (ROS) and screening tests will assist in determining if the patient is a suitable candidate for refractive surgery, as CF/CFTR-RD can impact the health of the cornea. Collaboration with other medical professionals who care for these patients is encouraged to ensure that their CF/CFTR-RD symptoms are best controlled via systemic and other treatment options. This will assist in reducing the severity of their ocular manifestations before and after surgery.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Alex H Brown
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Christian A Sulit
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Wyatt M Corbin
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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Guidelines for Cystic Fibrosis Carrier Screening in the Prenatal/Preconception Period. Obstet Gynecol Surv 2022; 77:606-610. [DOI: 10.1097/ogx.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Roda J, Pinto-Silva C, Silva IA, Maia C, Almeida S, Ferreira R, Oliveira G. New drugs in cystic fibrosis: what has changed in the last decade? Ther Adv Chronic Dis 2022; 13:20406223221098136. [PMID: 35620188 PMCID: PMC9128052 DOI: 10.1177/20406223221098136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Cystic fibrosis (CF), a life-limiting chronic disease caused by mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, affects more than 90,000 people worldwide. Until recently, the only available treatments were directed to symptom control, but they failed to change the course of the disease. New drugs developed in the last decade have the potential to change the expression, function, and stability of CFTR protein, targeting the basic molecular defect. The authors seek to provide an update on the new drugs, with a special focus on the most promising clinical trials that have been carried out to date. These newly approved drugs that target specific CFTR mutations are mainly divided into two main groups of CFTR modulators: potentiators and correctors. New therapies have opened the door for potentially disease-modifying, personalized treatments for patients with CF.
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Affiliation(s)
- Juliana Roda
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitario de Coimbra EPE Hospital Pediátrico de Coimbra, Avenida Afonso Romão 3000-602 Coimbra, Portugal
| | - Catarina Pinto-Silva
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitário de Coimbra EPE, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Iris A.I. Silva
- BioISI – Biosystems and Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Carla Maia
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitário de Coimbra EPE, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Susana Almeida
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitário de Coimbra EPE, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Ricardo Ferreira
- Pediatric Gastroenterology and Nutrition Unit, Centro Hospitalar e Universitário de Coimbra EPE, Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Guiomar Oliveira
- Centro de Desenvolvimento da Criança e Centro de Investigação e Formação Clínica, Centro Hospitalar e Universitario de Coimbra EPE, Hospital Pediátrico de Coimbra, Coimbra, Portugal
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Lima EDS, Pezzin LS, Fensterseifer AC, Pinto LA. Frequency of CFTR variants in southern Brazil and indication for modulators therapy in patients with cystic fibrosis. Genet Mol Biol 2021; 45:e20200275. [PMID: 34874053 PMCID: PMC8650020 DOI: 10.1590/1678-4685-gmb-2020-0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
This is a descriptive cross-sectional study that aims to determine the distribution of the CFTR causing variant in a group of patients at a cystic fibrosis (CF) center in southern Brazil, as well as to describe causing variants that are treatable with mutation-specific drugs. Ninety-two patients from a CF reference center were assessed in this research, all of them with a clinical diagnosis of CF and both alleles identified with pathogenic variants. The most prevalent causing variants were F508del, R1162X, G542X, and N1303K. As for patients with a mutation-specific drug indication, 69.6 % were candidates for the use of Elexacaftor/Tezacaftor/Ivacaftor (Trikafta®), 44.6 % for the use of Tezacaftor/Ivacaftor (Symdeko®), and 35.9 % for the use of Lumacaftor/Ivacaftor (Orkambi®). For the use of Ivacaftor (Kalydeco®), only two patients (2.2 %) were candidates following the Brazilian agency approval. According to the FDA, 10 patients would be candidates for Ivacaftor (10.9 %). Causing variants of classes I and II, which are related to a major severity of the illness, were identified in 135 of 184 alleles (73.3 %). In this study, more than 2/3 of the patients were candidates for the use of CFTR modulators therapy.
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Affiliation(s)
- Eliandra da Silveira Lima
- Pontifícia Universidade Católica do Rio Grande do Sul, Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Luíse Sgarabotto Pezzin
- Pontifícia Universidade Católica do Rio Grande do Sul, Pós-graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | | | - Leonardo Araújo Pinto
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Porto Alegre, RS, Brazil
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Guggino WB, Cebotaru L. Gene Therapy for Cystic Fibrosis Paved the Way for the Use of Adeno-Associated Virus in Gene Therapy. Hum Gene Ther 2021; 31:538-541. [PMID: 32283956 DOI: 10.1089/hum.2020.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Shortly after the cystic fibrosis (CF) gene was identified in 1989, the race began to develop a gene therapy for this condition. Major efforts utilized full-length cystic fibrosis transmembrane conductance regulator packaged into adenovirus, adeno-associated virus (AAV), or liposomes and delivered to the airways. The drive to find a treatment for CF based on gene therapy drove the early stages of gene therapy in general, particularly those involving AAV gene therapy. Since general overviews of CF gene therapy have already been published, this review considers specifically the efforts using AAV and is focused on honoring the contributions of Dr. Barrie Carter.
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Affiliation(s)
- William B Guggino
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Liudmila Cebotaru
- Department of Physiology, Johns Hopkins University, Baltimore, Maryland, USA
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Rooj AK, Cormet-Boyaka E, Clark EB, Qadri YJ, Lee W, Boddu R, Agarwal A, Tambi R, Uddin M, Parpura V, Sorscher EJ, Fuller CM, Berdiev BK. Association of cystic fibrosis transmembrane conductance regulator with epithelial sodium channel subunits carrying Liddle's syndrome mutations. Am J Physiol Lung Cell Mol Physiol 2021; 321:L308-L320. [PMID: 34037494 DOI: 10.1152/ajplung.00298.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The association of the cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) in the pathophysiology of cystic fibrosis (CF) is controversial. Previously, we demonstrated a close physical association between wild-type (WT) CFTR and WT ENaC. We have also shown that the F508del CFTR fails to associate with ENaC unless the mutant protein is rescued pharmacologically or by low temperature. In this study, we present the evidence for a direct physical association between WT CFTR and ENaC subunits carrying Liddle's syndrome mutations. We show that all three ENaC subunits bearing Liddle's syndrome mutations (both point mutations and the complete truncation of the carboxy terminus), could be coimmunoprecipitated with WT CFTR. The biochemical studies were complemented by fluorescence lifetime imaging microscopy (FLIM), a distance-dependent approach that monitors protein-protein interactions between fluorescently labeled molecules. Our measurements revealed significantly increased fluorescence resonance energy transfer between CFTR and all tested ENaC combinations as compared with controls (ECFP and EYFP cotransfected cells). Our findings are consistent with the notion that CFTR and ENaC are within reach of each other even in the setting of Liddle's syndrome mutations, suggestive of a direct intermolecular interaction between these two proteins.
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Affiliation(s)
- Arun K Rooj
- Department of Cell, Developmental & Integrative Biology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Edlira B Clark
- Department of Cell, Developmental & Integrative Biology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Yawar J Qadri
- Department of Anesthesiology, The Emory University School of Medicine, Atlanta, Georgia
| | - William Lee
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Ravindra Boddu
- Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Anupam Agarwal
- Department of Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Richa Tambi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mohammed Uddin
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Vladimir Parpura
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Eric J Sorscher
- Department of Pediatrics, The Emory University School of Medicine, Atlanta, Georgia
| | - Cathy M Fuller
- Department of Cell, Developmental & Integrative Biology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Bakhrom K Berdiev
- Department of Cell, Developmental & Integrative Biology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Divac Rankov A, Kusic-Tisma J, Ljujic M, Nikolic A, Milosevic K, Vilotijevic Dautovic G, Radojkovic D. Molecular Diagnostics of Cystic Fibrosis in Serbia: Our Approach to Meet the Diagnostic Challenges. Genet Test Mol Biomarkers 2021; 24:212-216. [PMID: 32286879 DOI: 10.1089/gtmb.2019.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: High heterogeneity levels of cystic fibrosis transmembrane regulator (CFTR) are manifested in different populations. The aim of this study was to analyze comprehensively all mutations in the CFTR gene in Serbian patients with cystic fibrosis (CF) and to use the findings to propose a testing algorithm for the Serbian population. Materials and Methods: Cascade screening was employed to detect mutations in the CFTR gene of 90 patients suspected of having CF, using polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism or PCR-mediated site directed mutagenesis, Sanger sequencing, and/or next-generation sequencing. Results: This is the first report for the Serbian CF population where single nucleotide polymorphisms, small insertions and deletions, large genome rearrangements, and copy number variants were analyzed in detail. A high degree of heterogeneity within the CFTR was documented among our cohort of 90 patients. We identified 19 CF-causing mutations and 3 with varying consequences, including a previously unreported deletion of the entire exon 11. Conclusion: Considering the spectrum and frequency of mutations found, we recommend a multistep sequencing algorithm in combination with evaluation of large rearrangements for future analyses of the CFTR gene in the Serbian population.
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Affiliation(s)
- Aleksandra Divac Rankov
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Jelena Kusic-Tisma
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Mila Ljujic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Nikolic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Katarina Milosevic
- Department for Pulmonary and Auergology, University Children's Hospital, Belgrade, Serbia
| | | | - Dragica Radojkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
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13
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Wei T, Sui H, Su Y, Cheng W, Liu Y, He Z, Ji Q, Xu C. Research advances in molecular mechanisms underlying the pathogenesis of cystic fibrosis: From technical improvement to clinical applications (Review). Mol Med Rep 2020; 22:4992-5002. [PMID: 33173976 PMCID: PMC7646950 DOI: 10.3892/mmr.2020.11607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022] Open
Abstract
Cystic fibrosis (CF) is a chronic disease causing severe impairment to the respiratory system and digestive tracts. Currently, CF is incurable. As an autosomal recessive disorder, the morbidity of CF is significantly higher among Caucasians of European descent, whereas it is less pervasive among African and Asian populations. The disease is caused by identical mutations (homozygosity) or different mutations (heterozygosity) of an autosomal recessive mutation at position 7q31.2-q31.1 of chromosome 7. Diagnostic criteria and guidelines work concurrently with laboratory detection to facilitate precise CF detection. With technological advances, the understanding of CF pathogenesis has reached an unprecedented level, allowing for increasingly precise carrier screening, more effective early stage CF intervention and improved prognostic outcomes. These advances significantly increase the life quality and expectancy of patients with CF. Given the numerous improvements in the field of CF, the current review summarized the technical advances in the study of the molecular mechanisms underlying CF, as well as how these improvements facilitate the clinical outcomes of CF. Furthermore, challenges and obstacles to overcome are discussed.
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Affiliation(s)
- Tao Wei
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Hongshu Sui
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Yanping Su
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Wanjing Cheng
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Yunhua Liu
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Zilin He
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Qingchao Ji
- Department of Histology and Embryology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, Shandong 271000, P.R. China
| | - Changlong Xu
- Reproductive Medical Center, Nanning Second People's Hospital, Nanning, Guangxi Zhuang Autonomous Region 530031, P.R. China
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14
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Noorian S, Khonsari NM, Savad S, Hakak-Zargar B, Voth T, Kabir K. Whole-Exome Sequencing in Idiopathic Short Stature: Rare Mutations Affecting Growth. J Pediatr Genet 2020; 10:284-291. [PMID: 34849273 DOI: 10.1055/s-0040-1716400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022]
Abstract
Idiopathic short stature (ISS) is a common diagnosis of exclusion in patients with short stature (SS). In this article, we aimed to identify the genetic causes of SS in patients with ISS and investigate treatment options. Fourteen children with diagnosis of ISS were identified, and whole-exome sequencing (WES) was subsequently conducted on blood-derived DNA. Five patients were correctly diagnosed with ISS and four had rare mutations that have not been previously reported. Four patients had mutations known to cause SS and one had a mutation that was known not to affect height. WES can help identify rare mutations implicated in ISS.
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Affiliation(s)
- Shahab Noorian
- Department of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | | | - Benyamin Hakak-Zargar
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Tessa Voth
- Department of Biomedical Physiology and Kinesiology, Faculty of Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Koroush Kabir
- Department of Community Medicine and Epidemiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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15
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Bañuls L, Pellicer D, Castillo S, Navarro-García MM, Magallón M, González C, Dasí F. Gene Therapy in Rare Respiratory Diseases: What Have We Learned So Far? J Clin Med 2020; 9:E2577. [PMID: 32784514 PMCID: PMC7463867 DOI: 10.3390/jcm9082577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Gene therapy is an alternative therapy in many respiratory diseases with genetic origin and currently without curative treatment. After five decades of progress, many different vectors and gene editing tools for genetic engineering are now available. However, we are still a long way from achieving a safe and efficient approach to gene therapy application in clinical practice. Here, we review three of the most common rare respiratory conditions-cystic fibrosis (CF), alpha-1 antitrypsin deficiency (AATD), and primary ciliary dyskinesia (PCD)-alongside attempts to develop genetic treatment for these diseases. Since the 1990s, gene augmentation therapy has been applied in multiple clinical trials targeting CF and AATD, especially using adeno-associated viral vectors, resulting in a good safety profile but with low efficacy in protein expression. Other strategies, such as non-viral vectors and more recently gene editing tools, have also been used to address these diseases in pre-clinical studies. The first gene therapy approach in PCD was in 2009 when a lentiviral transduction was performed to restore gene expression in vitro; since then, transcription activator-like effector nucleases (TALEN) technology has also been applied in primary cell culture. Gene therapy is an encouraging alternative treatment for these respiratory diseases; however, more research is needed to ensure treatment safety and efficacy.
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Affiliation(s)
- Lucía Bañuls
- Research group on Rare Respiratory Diseases (ERR), Department of Physiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (L.B.); (D.P.); (M.M.)
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
| | - Daniel Pellicer
- Research group on Rare Respiratory Diseases (ERR), Department of Physiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (L.B.); (D.P.); (M.M.)
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
| | - Silvia Castillo
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
- Paediatrics Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - María Mercedes Navarro-García
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
| | - María Magallón
- Research group on Rare Respiratory Diseases (ERR), Department of Physiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (L.B.); (D.P.); (M.M.)
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
| | - Cruz González
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
- Pneumology Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Francisco Dasí
- Research group on Rare Respiratory Diseases (ERR), Department of Physiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; (L.B.); (D.P.); (M.M.)
- Research group on Rare Respiratory Diseases (ERR), Instituto de Investigación Sanitaria INCLIVA, Fundación Investigación Hospital Clínico Valencia, Avda. Menéndez y Pelayo, 4, 46010 Valencia, Spain; (S.C.); (M.M.N.-G.); (C.G.)
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16
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Lalonde E, Rentas S, Lin F, Dulik MC, Skraban CM, Spinner NB. Genomic Diagnosis for Pediatric Disorders: Revolution and Evolution. Front Pediatr 2020; 8:373. [PMID: 32733828 PMCID: PMC7360789 DOI: 10.3389/fped.2020.00373] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
Powerful, recent advances in technologies to analyze the genome have had a profound impact on the practice of medical genetics, both in the laboratory and in the clinic. Increasing utilization of genome-wide testing such as chromosomal microarray analysis and exome sequencing have lead a shift toward a "genotype-first" approach. Numerous techniques are now available to diagnose a particular syndrome or phenotype, and while traditional techniques remain efficient tools in certain situations, higher-throughput technologies have become the de facto laboratory tool for diagnosis of most conditions. However, selecting the right assay or technology is challenging, and the wrong choice may lead to prolonged time to diagnosis, or even a missed diagnosis. In this review, we will discuss current core technologies for the diagnosis of classic genetic disorders to shed light on the benefits and disadvantages of these strategies, including diagnostic efficiency, variant interpretation, and secondary findings. Finally, we review upcoming technologies posed to impart further changes in the field of genetic diagnostics as we move toward "genome-first" practice.
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Affiliation(s)
- Emilie Lalonde
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Stefan Rentas
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Fumin Lin
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew C. Dulik
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Cara M. Skraban
- Division of Human Genetics, Department of Pediatrics, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Nancy B. Spinner
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
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17
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Françoise A, Héry-Arnaud G. The Microbiome in Cystic Fibrosis Pulmonary Disease. Genes (Basel) 2020; 11:E536. [PMID: 32403302 PMCID: PMC7288443 DOI: 10.3390/genes11050536] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/20/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic disease with mutational changes leading to profound dysbiosis, both pulmonary and intestinal, from a very young age. This dysbiosis plays an important role in clinical manifestations, particularly in the lungs, affected by chronic infection. The range of microbiological tools has recently been enriched by metagenomics based on next-generation sequencing (NGS). Currently applied essentially in a gene-targeted manner, metagenomics has enabled very exhaustive description of bacterial communities in the CF lung niche and, to a lesser extent, the fungi. Aided by progress in bioinformatics, this now makes it possible to envisage shotgun sequencing and opens the door to other areas of the microbial world, the virome, and the archaeome, for which almost everything remains to be described in cystic fibrosis. Paradoxically, applying NGS in microbiology has seen a rebirth of bacterial culture, but in an extended manner (culturomics), which has proved to be a perfectly complementary approach to NGS. Animal models have also proved indispensable for validating microbiome pathophysiological hypotheses. Description of pathological microbiomes and correlation with clinical status and therapeutics (antibiotic therapy, cystic fibrosis transmembrane conductance regulator (CFTR) modulators) revealed the richness of microbiome data, enabling description of predictive and follow-up biomarkers. Although monogenic, CF is a multifactorial disease, and both genotype and microbiome profiles are crucial interconnected factors in disease progression. Microbiome-genome interactions are thus important to decipher.
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Affiliation(s)
- Alice Françoise
- UMR 1078 GGB, University of Brest, Inserm, EFS, F-29200 Brest, France;
| | - Geneviève Héry-Arnaud
- UMR 1078 GGB, University of Brest, Inserm, EFS, F-29200 Brest, France;
- Unité de Bactériologie, Pôle de Biologie-Pathologie, Centre Hospitalier Régional et Universitaire de Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
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18
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Michels M, Matte U, Fraga LR, Mancuso ACB, Ligabue-Braun R, Berneira EFR, Siebert M, Sanseverino MTV. Determining the pathogenicity of CFTR missense variants: Multiple comparisons of in silico predictors and variant annotation databases. Genet Mol Biol 2019; 42:560-570. [PMID: 31808782 PMCID: PMC6905453 DOI: 10.1590/1678-4685-gmb-2018-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/12/2018] [Indexed: 01/07/2023] Open
Abstract
Pathogenic variants in the Cystic Fibrosis Transmembrane Conductance Regulator
gene (CFTR) are responsible for cystic fibrosis (CF), the
commonest monogenic autosomal recessive disease, and
CFTR-related disorders in infants and youth. Diagnosis of such
diseases relies on clinical, functional, and molecular studies. To date, over
2,000 variants have been described on CFTR (~40% missense).
Since few of them have confirmed pathogenicity, in silico
analysis could help molecular diagnosis and genetic counseling. Here, the
pathogenicity of 779 CFTR missense variants was predicted by
consensus predictor PredictSNP and compared to annotations on CFTR2 and ClinVar.
Sensitivity and specificity analysis was divided into modeling and validation
phases using just variants annotated on CFTR2 and/or ClinVar that were not in
the validation datasets of the analyzed predictors. After validation phase, MAPP
and PhDSNP achieved maximum specificity but low sensitivity. Otherwise, SNAP had
maximum sensitivity but null specificity. PredictSNP, PolyPhen-1, PolyPhen-2,
SIFT, nsSNPAnalyzer had either low sensitivity or specificity, or both. Results
showed that most predictors were not reliable when analyzing
CFTR missense variants, ratifying the importance of
clinical information when asserting the pathogenicity of CFTR
missense variants. Our results should contribute to clarify decision making when
classifying the pathogenicity of CFTR missense variants.
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Affiliation(s)
- Marcus Michels
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ursula Matte
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Lucas Rosa Fraga
- Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Rodrigo Ligabue-Braun
- Programa de Pós-Graduação em Biologia Celular e Molecular, Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marina Siebert
- Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Teresa Vieira Sanseverino
- Programa de Pós-Graduação em Genética e Biologia Molecular, Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Hammoudeh S, Gadelhak W, AbdulWahab A, Al-Langawi M, Janahi IA. Approaching two decades of cystic fibrosis research in Qatar: a historical perspective and future directions. Multidiscip Respir Med 2019; 14:29. [PMID: 31583102 PMCID: PMC6771098 DOI: 10.1186/s40248-019-0193-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic disease caused by a defect of CF transmembrane conductance regulator (CFTR) gene. CF affects multiple systems, predominantly with respiratory involvement. In Qatar, researchers have been exploring various aspects of the disease for almost 20 years. PubMed and Google Scholar were reviewed for articles related to CF in Qatar. The first publication appeared in the year 2000. Since then, several studies have been conducted on CF patients in Qatar considering a variety of topics. The presence of the CFTR I1234V mutation in a certain Arab tribe stands out as a distinguishing characteristic of CF patients in Qatar when compared to the larger Arab region or even worldwide. We aim here to summarize the existing CF research conducted in Qatar over the years as well as to introduce topics for future research.
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Affiliation(s)
- Samer Hammoudeh
- 1Medical Research Center, Research Affairs, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Wessam Gadelhak
- 1Medical Research Center, Research Affairs, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Atqah AbdulWahab
- Pediatric Pulmonology, Pediatric Medicine, Sidra Medicine, PO Box 26999, Doha, Qatar
| | - Mona Al-Langawi
- 3Internal Medicine, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ibrahim A Janahi
- Pediatric Pulmonology, Pediatric Medicine, Sidra Medicine, PO Box 26999, Doha, Qatar
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20
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Sadik I, Pérez de Algaba I, Jiménez R, Benito C, Blasco-Alonso J, Caro P, Navas-López VM, Pérez-Frías J, Pérez E, Serrano J, Yahyaoui R. Initial Evaluation of Prospective and Parallel Assessments of Cystic Fibrosis Newborn Screening Protocols in Eastern Andalusia: IRT/IRT versus IRT/PAP/IRT. Int J Neonatal Screen 2019; 5:32. [PMID: 33072991 PMCID: PMC7510193 DOI: 10.3390/ijns5030032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022] Open
Abstract
Identifying newborns at risk for cystic fibrosis (CF) by newborn screening (NBS) using dried blood spot (DBS) specimens provides an opportunity for presymptomatic detection. All NBS strategies for CF begin with measuring immunoreactive trypsinogen (IRT). Pancreatitis-associated protein (PAP) has been suggested as second-tier testing. The main objective of this study was to evaluate the analytical performance of an IRT/PAP/IRT strategy versus the current IRT/IRT strategy over a two-year pilot study including 68,502 newborns. The design of the study, carried out in a prospective and parallel manner, allowed us to compare four different CF-NBS protocols after performing a post hoc analysis. The best PAP cutoff point and the potential sources of PAP false positive results in our non-CF newborn population were also studied. 14 CF newborns were detected, resulting in an overall CF prevalence of 1/4, 893 newborns. The IRT/IRT algorithm detected all CF cases, but the IRT/PAP/IRT algorithm failed to detect one case of CF. The IRT/PAP/IRT with an IRT-dependent safety net protocol was a good alternative to improve sensitivity to 100%. The IRT × PAP/IRT strategy clearly performed better, with a sensitivity of 100% and a positive predictive value (PPV) of 39%. Our calculated optimal cutoffs were 2.31 µg/L for PAP and 167.4 µg2/L2 for IRT × PAP. PAP levels were higher in females and newborns with low birth weight. PAP false positive results were found mainly in newborns with conditions such as prematurity, sepsis, and hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Ilham Sadik
- Clinical Laboratory, Hospital La Línea de la Concepción, 11300 Cádiz, Spain
| | - Inmaculada Pérez de Algaba
- Laboratory of Metabolic Disorders and Newborn Screening Center of Eastern Andalusia, Málaga Regional University Hospital, Avenida Arroyo de los Angeles s/n, 29011 Málaga, Spain
| | - Rocío Jiménez
- Laboratory of Metabolic Disorders and Newborn Screening Center of Eastern Andalusia, Málaga Regional University Hospital, Avenida Arroyo de los Angeles s/n, 29011 Málaga, Spain
| | - Carmen Benito
- Department of Genetics, Málaga Regional University Hospital, 29011 Málaga, Spain
| | - Javier Blasco-Alonso
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
| | - Pilar Caro
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
- Department of Pharmacology and Pediatrics, University of Málaga, 29071 Málaga, Spain
| | - Víctor M. Navas-López
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
| | - Javier Pérez-Frías
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
- Department of Pharmacology and Pediatrics, University of Málaga, 29071 Málaga, Spain
| | - Estela Pérez
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
- Department of Pharmacology and Pediatrics, University of Málaga, 29071 Málaga, Spain
| | - Juliana Serrano
- Department of Pediatrics, Málaga Regional University Hospital, 29011 Málaga, Spain
| | - Raquel Yahyaoui
- Laboratory of Metabolic Disorders and Newborn Screening Center of Eastern Andalusia, Málaga Regional University Hospital, Avenida Arroyo de los Angeles s/n, 29011 Málaga, Spain
- Institute of Biomedical Research in Málaga-IBIMA, 29010 Málaga, Spain
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21
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Sohn YB, Ko JM, Jang JY, Seong MW, Park SS, Suh DI, Ko JS, Shin CH. Deletion of exons 16–17b of CFTR is frequently identified in Korean patients with cystic fibrosis. Eur J Med Genet 2019; 62:103681. [DOI: 10.1016/j.ejmg.2019.103681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 01/18/2023]
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22
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Bono-Neri F, Romano C, Isedeh A. Cystic Fibrosis: Advancing Along the Continuum. J Pediatr Health Care 2019; 33:242-254. [PMID: 30529125 DOI: 10.1016/j.pedhc.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/09/2018] [Accepted: 08/19/2018] [Indexed: 12/12/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder resulting from a mutation in the gene which encodes a cellular transmembrane protein channel known as the CF transmembrane conductance regulator. Located systemically on the surface of numerous cells, these altered channels yield multisystem dysfunction. Typical manifestations seen are chronic, progressive, obstructive lung disease, pancreatic insufficiency, CF-related diabetes mellitus, malabsorption and malnutrition, liver disease, and infertility.Once considered a pediatric disorder, through developments in innovative care and therapeutic modalities, CF now spans the life continuum and has established itself as an ageless disease. Facing management of maturing-life issues, advanced practice nurses (APNs) in pediatrics now find themselves needing to collaborate with or facilitate transition of care to other APNs, such as nurse midwives and adult APNs, as well as their counterpart specialists in medicine, all while maintaining open communication with the patient, family and managing CF center.
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Yiallouros PK, Kouis P, Pirpa P, Michailidou K, Loizidou MA, Potamiti L, Kalyva M, Koutras G, Kyriacou K, Hadjisavvas A. Wide phenotypic variability in RSPH9-associated primary ciliary dyskinesia: review of a case-series from Cyprus. J Thorac Dis 2019; 11:2067-2075. [PMID: 31285900 DOI: 10.21037/jtd.2019.04.71] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary ciliary dyskinesia (PCD) is an inherited ciliary motility disorder caused by mutations in at least 40 genes. RSPH9 gene mutations encoding aberrant radial spoke head proteins have been linked with PCD. The clinical spectrum extent of RSPH9 gene mutations remains to date largely unknown. We aimed to describe the diagnostic and clinical phenotype in a case-series of RSPH9-associated PCD. Methods We performed whole exome sequencing in suspect patients from Cyprus who on repeated cilia biopsies demonstrated loss of the central pair apparatus on Transmission Electron Microscopy (TEM) and rotary beating patterns on High Speed Video Microscopy (HSVM), compatible to findings described previously in PCD patients bearing pathogenic RSPH9 mutations. In cases confirmed by genetic testing, we reviewed diagnostic, demographic and clinical data, as well as anthropometric and spirometric measurements. Results We diagnosed 7 individuals (5 females) homozygous for the novel RSPH9 splice site mutation c.670+2T>C in intron 4, who originated from two families. Despite bearing the same genetic variant, patients presented a highly variable age (median 47.9 years; range, 6.6 to 51.4 years) and with a diverse clinical picture, all reporting a history of chronic or recurrent wet cough (100%), and at varying frequencies neonatal respiratory distress (43%), chronic rhinosinusitis (71%), and wheezing (43%). Complications such as bronchiectasis (71%), history of pneumonia(s) (57%) and surgical interventions (43%) clustered in some patients displaying typical PCD, but not in others with milder phenotypes. BMI-z scores (median: 0.53; range, -0.69 to 1.52), FEV1-z scores (median: -0.37; range: -1.79 to 0.22) and FVC z-scores (median: -0.80; range: -2.01 to 0.36) were on average within the normal range, although slightly reduced. Conclusions In conclusion, RSPH9-associated PCD disease demonstrates wide phenotypic variability. In some cases, mild clinical presentation is difficult to justify diagnostic work-up, highlighting the importance of wider adoption of genetic diagnostics. Larger studies are needed to assess variability of clinical spectrum associated to alterations of PCD genes.
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Affiliation(s)
- Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus.,Pediatric Pulmonology Unit, Hospital 'Archbishop Makarios III', Nicosia, Cyprus
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Panayiota Pirpa
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriaki Michailidou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Maria A Loizidou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Louiza Potamiti
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Margarita Kalyva
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Kyriacos Kyriacou
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Andreas Hadjisavvas
- Department of Electron Microscopy/Molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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Bergougnoux A, D'Argenio V, Sollfrank S, Verneau F, Telese A, Postiglione I, Lackner KJ, Claustres M, Castaldo G, Rossman H, Salvatore F, Raynal C. Multicenter validation study for the certification of a CFTR gene scanning method using next generation sequencing technology. Clin Chem Lab Med 2019; 56:1046-1053. [PMID: 29427548 DOI: 10.1515/cclm-2017-0553] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/14/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many European laboratories offer molecular genetic analysis of the CFTR gene using a wide range of methods to identify mutations causative of cystic fibrosis (CF) and CFTR-related disorders (CFTR-RDs). Next-generation sequencing (NGS) strategies are widely used in diagnostic practice, and CE marking is now required for most in vitro diagnostic (IVD) tests in Europe. The aim of this multicenter study, which involved three European laboratories specialized in CF molecular analysis, was to evaluate the performance of Multiplicom's CFTR MASTR Dx kit to obtain CE-IVD certification. METHODS A total of 164 samples, previously analyzed with well-established "reference" methods for the molecular diagnosis of the CFTR gene, were selected and re-sequenced using the Illumina MiSeq benchtop NGS platform. Sequencing data were analyzed using two different bioinformatic pipelines. Annotated variants were then compared to the previously obtained reference data. RESULTS AND CONCLUSIONS The analytical sensitivity, specificity and accuracy rates of the Multiplicom CFTR MASTR assay exceeded 99%. Because different types of CFTR mutations can be detected in a single workflow, the CFTR MASTR assay simplifies the overall process and is consequently well suited for routine diagnostics.
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Affiliation(s)
- Anne Bergougnoux
- Laboratory of Molecular Genetics, Montpellier University Hospital, Montpellier Cedex 5, France.,Rare Genetic Diseases Laboratory, Institut Universitaire de Recherche Clinique, University of Montpellier, Montpellier Cedex 5, France
| | - Valeria D'Argenio
- CEINGE-Biotecnologie Avanzate, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Stefanie Sollfrank
- Department of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Fanny Verneau
- Laboratory of Molecular Genetics, Montpellier University Hospital, Montpellier Cedex 5, France
| | | | | | - Karl J Lackner
- Department of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Mireille Claustres
- Rare Genetic Diseases Laboratory, Institut Universitaire de Recherche Clinique, University of Montpellier, Montpellier Cedex 5, France
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Heidi Rossman
- Department of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany, Phone: +496131177297
| | - Francesco Salvatore
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145 Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, via S. Pansini 5, 80131 Naples, Italy, Phone: +390817463648
| | - Caroline Raynal
- Laboratory of Molecular Genetics, Montpellier University Hospital, 34093 Montpellier Cedex 5, France.,Rare Genetic Diseases Laboratory, Institut Universitaire de Recherche Clinique, EA 7402, University of Montpellier, 34000 Montpellier Cedex 5, France, Phone: +33(0)411759879
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25
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Khan H, Mew N, Kaufman S, Yazigi N, Fishbein T, Khan K. Unusual Cystic Fibrosis Transmembrane Conductance Regulator Mutations and Liver Disease: A Case Series and Review of the Literature. Transplant Proc 2019; 51:790-793. [DOI: 10.1016/j.transproceed.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/27/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022]
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26
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Rosa KMD, Lima EDSD, Machado CC, Rispoli T, Silveira VD, Ongaratto R, Comaru T, Pinto LA. Genetic and phenotypic traits of children and adolescents with cystic fibrosis in Southern Brazil. ACTA ACUST UNITED AC 2019; 44:498-504. [PMID: 30726326 PMCID: PMC6459751 DOI: 10.1590/s1806-37562017000000418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/12/2017] [Indexed: 11/22/2022]
Abstract
Objectives: To characterize the main identified mutations on cystic fibrosis transmembrane conductance regulator (CFTR) in a group of children and adolescents at a cystic fibrosis center and its association with the clinical and laboratorial characteristics. Method: Descriptive cross-sectional study including patients with cystic fibrosis who had two alleles identified with CFTR mutation. Clinical, anthropometrical, laboratorial and pulmonary function (spirometry) data were collected from patients’ records in charts and described with the results of the sample genotyping. Results: 42 patients with cystic fibrosis were included in the study. The most frequent mutation was F508del, covering 60 alleles (71.4%). The second most common mutation was G542X (six alleles, 7.1%), followed by N1303K and R1162X mutations (both with four alleles each). Three patients (7.14%) presented type III and IV mutations, and 22 patients (52.38%) presented homozygous mutation for F508del. Thirty three patients (78.6%) suffered of pancreatic insufficiency, 26.2% presented meconium ileus, and 16.7%, nutritional deficit. Of the patients in the study, 59.52% would be potential candidates for the use of CFTR-modulating drugs. Conclusions: The mutations of CFTR identified more frequently were F508del and G542X. These are type II and I mutations, respectively. Along with type III, they present a more severe cystic fibrosis phenotype. More than half of the sample (52.38%) presented homozygous mutation for F508del, that is, patients who could be treated with Lumacaftor/Ivacaftor. Approximately 7% of the patients (7.14%) presented type III and IV mutations, therefore becoming candidates for the treatment with Ivacaftor.
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Affiliation(s)
- Katiana Murieli da Rosa
- . Pediatric Residency Program, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | - Eliandra da Silveira de Lima
- . Post-Graduate Degree in Pediatrics and Children's Health, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | - Camila Correia Machado
- . Medical School , Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | - Thaiane Rispoli
- . Post-Graduate Degree in Cell and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | | | - Renata Ongaratto
- . Post-Graduate Degree in Pediatrics and Children's Health, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | - Talitha Comaru
- . Post-Graduate Degree in Pediatrics and Children's Health, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
| | - Leonardo Araújo Pinto
- . Centro Infantil, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brazil
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Mogul DB, Brereton N, Carson KA, Pittarelli M, Daniel H, Torbenson M, Schwarz KB. Development of a Dietary Methyl Donor Food Frequency Questionnaire to Assess Folate and Vitamin B 12 Status in Children with Chronic Hepatitis B Virus Infection. J Pediatr 2018; 203:41-46.e2. [PMID: 30243534 DOI: 10.1016/j.jpeds.2018.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To develop a dietary methyl donor food frequency questionnaire (DMD-FFQ) that is validated in a cohort of US children and to determine whether the consumption of folate and vitamin B12, principal DMDs, correlates with HBV DNA levels and its methylation density. STUDY DESIGN We developed a semiquantitative DMD-FFQ to estimate intake of folate and vitamin B12 and validated this instrument against a 24-hour dietary recall and biomarkers-red blood cell folate, serum vitamin B12, and homocysteine-in 35 children with chronic HBV infection without other medical comorbidities. Estimates of DMD, as well as the serum biomarkers, were correlated with the methylation density of HBV CpG island 2 and HBV DNA levels. RESULTS Folate per kilogram of body weight by the DMD-FFQ correlated positively with 24-hour recall (r = 0.60; P < .001) and red blood cell folate (r = 0.40; P = .02), and negatively with homocysteine (r = -0.54; P < .001). Vitamin B12 per kilogram by DMD-FFQ also correlated positively with 24-hour recall (r = 0.57; P < .001) and serum vitamin B12 (r = 0.36, P = .04), and negatively with homocysteine (r = -0.44; P = .008). Neither DMD intake (from DMD-FFQ or 24-hour recall) nor serum biomarkers correlated with HBV DNA levels or its methylation density. CONCLUSIONS Our DMD-FFQ correlates well with a 24-hour recall and circulating biomarkers. Although little evidence existed that consumption of these micronutrients correlated with HBV replication, this tool could prove useful for investigating epigenetic modification by diet for several pediatric diseases.
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Affiliation(s)
- Douglas B Mogul
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Nga Brereton
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn A Carson
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maria Pittarelli
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hubert Daniel
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
| | | | - Kathleen B Schwarz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD
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28
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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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O'Neal WK, Knowles MR. Cystic Fibrosis Disease Modifiers: Complex Genetics Defines the Phenotypic Diversity in a Monogenic Disease. Annu Rev Genomics Hum Genet 2018; 19:201-222. [DOI: 10.1146/annurev-genom-083117-021329] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In many respects, genetic studies in cystic fibrosis (CF) serve as a paradigm for a human Mendelian genetic success story. From recognition of the condition as a heritable pathological entity to implementation of personalized treatments based on genetic findings, this multistep pathway of progress has focused on the genetic underpinnings of CF clinical disease. Along this path was the recognition that not all CFTR gene mutations produce the same disease and the recognition of the complex, multifactorial nature of CF genotype–phenotype relationships. The non- CFTR genetic components (gene modifiers) that contribute to variation in phenotype are the focus of this review. A multifaceted approach involving candidate gene studies, genome-wide association studies, and gene expression studies has revealed significant gene modifiers for multiple CF phenotypes. The bold challenges for the future are to integrate the findings into our understanding of CF pathogenesis and to use the knowledge to develop novel therapies.
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Affiliation(s)
- Wanda K. O'Neal
- Cystic Fibrosis/Pulmonary Research and Treatment Center, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA;,
| | - Michael R. Knowles
- Cystic Fibrosis/Pulmonary Research and Treatment Center, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA;,
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Fernández-Lorenzo AE, Moreno-Álvarez A, Colon-Mejeras C, Barros-Angueira F, Solar-Boga A, Sirvent-Gómez J, Couce ML, Leis R. V232D mutation in patients with cystic fibrosis: Not so rare, not so mild. Medicine (Baltimore) 2018; 97:e11397. [PMID: 29995784 PMCID: PMC6076148 DOI: 10.1097/md.0000000000011397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The frequency of some Cystic Fibrosis (CF) Transmembrane Conductance Regulator gene (CFTR) mutations varies between populations. Genetic testing during newborn screening (NBS) for CF can identify less common mutations with low clinical expression in childhood and previously considered mild but not fully characterized, such as the mutation p.Val232Asp (c.695T > A). The aim of this study was to describe CF patients with the V232D mutation. We identify CF children with the V232D mutation detected by NBS and compare them with CF adults with this mutation whose diagnosis was prompted by clinical symptoms in the same period. We studied clinical, biochemical, spirometric, and prognostic features in both populations. NBS program tested 276,523 children during a period of 14 years (2003-2017) and identified 54 cases of CF. Six children (11%) had the V232D mutation. Over the same period, 5 adults (age 37.6 ± 16.29 years old) with symptoms of CF and this mutation were also diagnosed. Follow-up duration was mean 10.1 years for adults and mean 6.5 years for children. In the adult group, lung function was impaired at diagnosis in all patients (Forced Expiratory Volume1-FEV1-67.12% ± 13.09) and worsened in children tested during evolution (FEV1first: 113%; FEV1last: 64%). Pancreatic insufficiency was present in adult group, with recurrent pancreatitis in 1 present. Although with less clinical expression in children, V232D is associated with pulmonary and pancreatic involvement during adulthood and CF cannot be considered mild. This mutation is present in 11% of all patients diagnosed with CF in our region. Its inclusion in some NBS programs should be taken into account in order to improve the prognosis of affected children.
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Affiliation(s)
- Ana E. Fernández-Lorenzo
- Department of Pediatrics, Hospital Teresa Herrera, Complejo Hospitalario Universitario A Coruña, A Coruña
- Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Moreno-Álvarez
- Department of Pediatrics, Hospital Teresa Herrera, Complejo Hospitalario Universitario A Coruña, A Coruña
| | - Cristóbal Colon-Mejeras
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS)
| | - Francisco Barros-Angueira
- Unidad de Medicina Molecular-Fundación Pública Galega de Medicina Xenómica, Hospital Clínico Universitario Santiago de Compostela
| | - Alfonso Solar-Boga
- Department of Pediatrics, Hospital Teresa Herrera, Complejo Hospitalario Universitario A Coruña, A Coruña
| | - Josep Sirvent-Gómez
- Department of Pediatrics, Hospital Teresa Herrera, Complejo Hospitalario Universitario A Coruña, A Coruña
| | - María L. Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS)
| | - Rosaura Leis
- Unit of Pediatrics Gastroenterology, Hepatology and Nutrition, Pediatrics Department, Hospital Clínico Universitario de Santiago, Pediatrics Nutrition Group-IDIS, CiberObn
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Influence of SNPs in Genes that Modulate Lung Disease Severity in a Group of Mexican Patients with Cystic Fibrosis. Arch Med Res 2018; 49:18-26. [PMID: 29703608 DOI: 10.1016/j.arcmed.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/11/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The variation in cystic fibrosis (CF) lung disease not always is explained by the CFTR genotype, so it has become apparent that modifier genes must play a considerable role in the phenotypic heterogeneity of CF, so we investigated the association of allelic variants in modifier genes that modulate the severity of lung function in a group of Mexican patients diagnosed with CF. METHODS We included 140 CF patients classified according to lung phenotype and analyzed 17 single nucleotide polymorphisms (SNPs) by TaqMan® allelic discrimination. RESULTS We demonstrated that patients with GG or GC genotype of the allelic variant rs11003125 (MBL2-550) of the MBL2 gene exhibit most of the lung manifestations at an earlier age; and the rs1042713 allelic variant of ADRB2 gene, showed statistical difference only with the age of first spirometry. When we used the dominant model, the MBL2 allele rs11003125 (MBL2-550; p = 0.022, Odds Ratio (OR) 2.87, 95% CI 1.14-7.27) was significantly associated with CF patients as risk factor, and the ADRB2 allele rs1042713 (p.Arg16Gly; p = 0.005, Odds Ratio (OR) 0.37, 95% CI 0.19-0.75) was significantly associated with CF patients as protect factor. CONCLUSIONS Our findings suggest that the MBL2 and ADRB2 genes exerts an important genetic influence on the lung disease in our patients. Taking into account our results, we insist on not leaving aside this type of studies, since having techniques such as GWAS or WES will be able to advance in achieving a better quality of life for CF patients with severe lung disease.
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CFTR Protein Function Modulation Therapy Is Finally Targeting Cystic Fibrosis-related Gastrointestinal Disease. J Pediatr Gastroenterol Nutr 2018; 66:372-373. [PMID: 29261530 DOI: 10.1097/mpg.0000000000001868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
OBJECTIVE Pancreatic insufficiency (PI) in cystic fibrosis (CF) patients is a crucial clinical marker for severity and disease progression. In our study, 125 modifier genes and their SNPs were associated between CF patients with PI or pancreatic sufficiency. METHODS We prospectively evaluated 214 CF patients admitted at 1 hospital for a 2-year period. The PI status was associated with clinical variables and SNPs related with inflammatory response considering CFTR mutations. Open Array technique was used to perform the SNPs identification. RESULTS For PI risk, after correction by multiple test, in CF patients and 2 CFTR mutations class I, II, and/or III, there were 6 SNPs with positive association (P < 0.005). The odds ratio amplitude was 0.087 (95% confidence interval [CI], 0.004-0.544) for rs9870255*CG (CTNNB1 gene) to 11.06 (95% CI, 1.746-252.3) for rs729302*AA (IRF5 gene). For all CF patients at the same time, 9 SNPs showed positive association. The odds ratio amplitude was 0.144 (95% CI, 0.028-0.602) for rs2348071*AA (PSMA3 gene) to 5.809 (95% CI, 1.536-37.54) for rs11702779*AA (RUNX1 gene). In our data, we observed the interaction between CFTR mutations, rs9870255*CTNNB1, rs9378805*IRF4, and rs7664617*KCNIP4 to PI status. CONCLUSIONS Multiple SNPs in inflammatory response genes showed association with PI considering the CFTR mutations screening.
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Guggino WB, Cebotaru L. Adeno-Associated Virus (AAV) gene therapy for cystic fibrosis: current barriers and recent developments. Expert Opin Biol Ther 2017; 17:1265-1273. [PMID: 28657358 DOI: 10.1080/14712598.2017.1347630] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Since the cystic fibrosis (CF) gene was discovered in 1989, researchers have worked to develop a gene therapy. One of the most promising and enduring vectors is the AAV, which has been shown to be safe. In particular, several clinical trials have been conducted with AAV serotype 2. All of them detected viral genomes, but identification of mRNA transduction was not consistent; clinical outcomes in Phase II studies were also inconsistent. The lack of a positive outcome has been attributed to a less-than-efficient viral infection by AAV2, a weak transgene promoter and the host immune response to the vector. Areas covered: Herein, the authors focus on AAV gene therapy for CF, evaluating past experience with this approach and identifying ways forward, based on the progress that has already been made in identifying and overcoming the limitations of AAV gene therapy. Expert opinion: Such progress makes it clear that this is an opportune time to push forward toward the development of a gene therapy for CF. Drugs to treat the basic defect in CF represent a remarkable advance but cannot treat a significant cohort of patients with rare mutations. Thus, there is a critical need to develop a gene therapy for those individuals.
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Affiliation(s)
- William B Guggino
- a Departments of Medicine and Physiology , Johns Hopkins University , Baltimore , MD , USA
| | - Liudmila Cebotaru
- a Departments of Medicine and Physiology , Johns Hopkins University , Baltimore , MD , USA
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Raraigh KS, Pastore MT, Greene L, Karczeski BA, Fisher LK, Ramsey BW, Langfelder-Schwind E. Diagnosis and Treatment of Cystic Fibrosis: A (Not-so) Simple Recessive Condition. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hypertonic Saline as a Useful Tool for Sputum Induction and Pathogen Detection in Cystic Fibrosis. Lung 2017; 195:431-439. [DOI: 10.1007/s00408-017-0008-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/24/2017] [Indexed: 11/25/2022]
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Lucarelli M. New era of cystic fibrosis: Full mutational analysis and personalized therapy. World J Med Genet 2017; 7:1-9. [DOI: 10.5496/wjmg.v7.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/19/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
Despite its apparently simple genetics, cystic fibrosis (CF) is a rather complex genetic disease. A lot of variability in the steps of the path from the cystic fibrosis transmembrane conductance regulator (CFTR) gene to the clinical manifestations originates an uncertain genotype - phenotype relationship. A major determinant of this uncertainty is the incomplete knowledge of the CFTR mutated genotypes, due to the high number of CFTR mutations and to the higher number of their combinations in trans and in cis. Also the very limited knowledge of functional effects of CFTR mutated alleles severely impairs our diagnostic and prognostic ability. The final phenotypic modulation exerted by CFTR modifier genes and interactome further complicates the framework. The next generation sequencing approach is a rapid, low-cost and high-throughput tool that allows a near complete structural characterization of CFTR mutated genotypes, as well as of genotypes of several other genes cooperating to the final CF clinical manifestations. This powerful method perfectly complements the new personalized therapeutic approach for CF. Drugs active on specific CFTR mutational classes are already available for CF patients or are in phase 3 trials. A complete genetic characterization has been becoming crucial for a correct personalized therapy. However, the need of a functional classification of each CFTR mutation potently arises. Future big efforts towards an ever more detailed knowledge of both structural and functional CFTR defects, coupled to parallel personalized therapeutic interventions decisive for CF cure can be foreseen.
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Affiliation(s)
- Marco Lucarelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Laboratory affiliated to Istituto Pasteur Italia - Fondazione Cenci Bolognetti, 00161 Rome, Italy
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Mukoviszidose. MED GENET-BERLIN 2016. [DOI: 10.1007/s11825-016-0105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Die Mukoviszidose gehört mit einer Inzidenz von etwa 1:3300 bis 1:4800 Neugeborenen zu den häufigsten autosomal-rezessiv erblichen Erkrankungen in Deutschland und ist mit einer hohen Morbidität und Mortalität assoziiert. Um die möglichst frühzeitige Einleitung einer Therapie zu ermöglichen, wurde mit der am 1. September 2016 in Kraft getretenen Novellierung der Richtlinie über die Früherkennung von Krankheiten bei Kindern bis zur Vollendung des 6. Lebensjahres durch den Gemeinsamen Bundesausschuss die Einführung eines Screenings auf Mukoviszidose im Neugeborenenalter beschlossen. Ferner konnte durch interdisziplinäre Behandlungskonzepte u. a. in spezialisierten Mukoviszidosezentren die Lebenserwartung in den letzten Jahrzehnten deutlich gesteigert werden. Mit der Entwicklung und zunehmenden Markteinführung mutationsspezifischer Therapien besteht erstmals die Möglichkeit, direkt in die Pathophysiologie der Mukoviszidose einzugreifen.
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Waters V, Stanojevic S, Ratjen F. Special considerations for the treatment of pulmonary exacerbations in children with cystic fibrosis. Expert Rev Respir Med 2016; 10:1221-1228. [PMID: 27718754 DOI: 10.1080/17476348.2017.1246963] [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] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is a disease characterized by recurrent flares of respiratory symptoms, known as pulmonary exacerbations (PExs), which have a cumulative, detrimental effect on lung function decline and overall mortality. Although much research has been done on the effects of PExs in adults with CF, considerably less is known about these events in young children with CF. Areas covered: This review describes the typical presentation of PExs in children and their impact on long-term clinical outcomes. Traditional and new monitoring techniques, such as pulmonary function testing using multiple breath washout, radiographic modalities and microbiological screening methods are reviewed. Finally, the choice, administration and duration of antimicrobial treatment as well as the potential use of antiviral therapy is discussed. Expert commentary: Although it is now well recognized that a significant proportion of patients do not recover their lung function following PExs, to date, little progress has been made to improve outcomes in this group. Additional therapies, to complement antimicrobials, may be required to treat infection and inflammation during PExs. Trials of anti-inflammatories such as corticosteroids or other novel drugs need to be done in the setting of PExs with the goal of complete lung function recovery for all individuals with CF.
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Affiliation(s)
- Valerie Waters
- a Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children , University of Toronto , Toronto , Canada
| | - Sanja Stanojevic
- b Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children , University of Toronto , Toronto , Canada
| | - Felix Ratjen
- b Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children , University of Toronto , Toronto , Canada
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Michl RK, Tabori H, Hentschel J, Beck JF, Mainz JG. Clinical approach to the diagnosis and treatment of cystic fibrosis and CFTR-related disorders. Expert Rev Respir Med 2016; 10:1177-1186. [DOI: 10.1080/17476348.2016.1240032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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da Cunha MF, Simonin J, Sassi A, Freund R, Hatton A, Cottart CH, Elganfoud N, Zoubairi R, Dragu C, Jais JP, Hinzpeter A, Edelman A, Sermet-Gaudelus I. Analysis of nasal potential in murine cystic fibrosis models. Int J Biochem Cell Biol 2016; 80:87-97. [PMID: 27717840 DOI: 10.1016/j.biocel.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 12/27/2022]
Abstract
The nasal epithelium of the mouse closely mimics the bioelectrical phenotype of the human airways. Ion transport across the nasal epithelium induces a nasal transepithelial potential difference. Its measurement by a relatively non-invasive method adapted from humans allows in vivo longitudinal measurements of CFTR-dependent ionic transport in the murine nasal mucosa. This test offers a useful tool to assess CFTR function in preclinical studies for novel therapeutics modulating CFTR activity. Here we extensively review work done to assess transepithelial transport in the murine respiratory epithelium in the basal state and after administration of CFTR modulators. Factors of variability and discriminative threshold between the CF and the WT mice for different readouts are discussed.
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Affiliation(s)
- Mélanie Faria da Cunha
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Juliette Simonin
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Ali Sassi
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Romain Freund
- Unité de Biostatistiques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Aurélie Hatton
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Charles-Henry Cottart
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Nadia Elganfoud
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Rachid Zoubairi
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Corina Dragu
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Jean Philippe Jais
- Unité de Biostatistiques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Hinzpeter
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
| | - Aleksander Edelman
- INSERM U 1151, Institut Necker Enfants Malades, Université Paris Sorbonne, Paris, France
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Rizk M, Pawlak S. A case report of embryo donation: ethical and clinical implications for psychologists. JOURNAL OF MEDICAL ETHICS 2016; 42:659-664. [PMID: 27343285 DOI: 10.1136/medethics-2015-103304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
Third-party reproduction is a growing field, and an increasing body of literature considers the ethics of embryo donation. Due to the psychosocial complexities that generally accompany the donation and/or use of donor embryos, psychologists can play a pivotal role in these specialised fertility cases. While laws in the USA are in place to regulate the medical procedures involved in embryo donation, only unenforceable guidelines exist for psychologists specialising in fertility cases. The presentation of this case study aims to: (1) clarify the ethical concerns that fertility psychologists should consider in similar situations by assessing whether American Society of Reproductive Medicine (ASRM) and the American Psychological Association (APA) guidelines compete or complement one another within this case of embryo donation and (2) consider the interests, obligations and rights of all parties involved. Several principles, standards and guidelines that must be considered are described. Overall, the APA Ethics Code and the ASRM Guidelines appear to complement one another for most aspects of this case. Fertility psychologists should consider the clinical implications of the interests, rights and duties of all involved parties, including themselves.
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Affiliation(s)
- Marianne Rizk
- Department of Psychology, University of Iowa, Iowa City, Iowa, USA
| | - Stacey Pawlak
- Department of Psychology, University of Iowa, Iowa City, Iowa, USA Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Boscardin E, Alijevic O, Hummler E, Frateschi S, Kellenberger S. The function and regulation of acid-sensing ion channels (ASICs) and the epithelial Na(+) channel (ENaC): IUPHAR Review 19. Br J Pharmacol 2016; 173:2671-701. [PMID: 27278329 DOI: 10.1111/bph.13533] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 12/30/2022] Open
Abstract
Acid-sensing ion channels (ASICs) and the epithelial Na(+) channel (ENaC) are both members of the ENaC/degenerin family of amiloride-sensitive Na(+) channels. ASICs act as proton sensors in the nervous system where they contribute, besides other roles, to fear behaviour, learning and pain sensation. ENaC mediates Na(+) reabsorption across epithelia of the distal kidney and colon and of the airways. ENaC is a clinically used drug target in the context of hypertension and cystic fibrosis, while ASIC is an interesting potential target. Following a brief introduction, here we will review selected aspects of ASIC and ENaC function. We discuss the origin and nature of pH changes in the brain and the involvement of ASICs in synaptic signalling. We expose how in the peripheral nervous system, ASICs cover together with other ion channels a wide pH range as proton sensors. We introduce the mechanisms of aldosterone-dependent ENaC regulation and the evidence for an aldosterone-independent control of ENaC activity, such as regulation by dietary K(+) . We then provide an overview of the regulation of ENaC by proteases, a topic of increasing interest over the past few years. In spite of the profound differences in the physiological and pathological roles of ASICs and ENaC, these channels share many basic functional and structural properties. It is likely that further research will identify physiological contexts in which ASICs and ENaC have similar or overlapping roles.
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Affiliation(s)
- Emilie Boscardin
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
| | - Omar Alijevic
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
| | - Edith Hummler
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland
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Xue R, Gu H, Qiu Y, Guo Y, Korteweg C, Huang J, Gu J. Expression of Cystic Fibrosis Transmembrane Conductance Regulator in Ganglia of Human Gastrointestinal Tract. Sci Rep 2016; 6:30926. [PMID: 27491544 PMCID: PMC4974654 DOI: 10.1038/srep30926] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/11/2016] [Indexed: 02/05/2023] Open
Abstract
CF is caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) which is an anion selective transmembrane ion channel that mainly regulates chloride transport, expressed in the epithelia of various organs. Recently, we have demonstrated CFTR expression in the brain, the spinal cord and the sympathetic ganglia. This study aims to investigate the expression and distribution of CFTR in the ganglia of the human gastrointestinal tract. Fresh tissue and formalin-fixed paraffin-embedded normal gastrointestinal tract samples were collected from eleven surgical patients and five autopsy cases. Immunohistochemistry, in situ hybridization, laser-assisted microdissection and nested reverse transcriptase polymerase chain reaction were performed. Expression of CFTR protein and mRNA was detected in neurons of the ganglia of all segments of the human gastrointestinal tract examined, including the stomach, duodenum, jejunum, ileum, cecum, appendix, colon and rectum. The extensive expression of CFTR in the enteric ganglia suggests that CFTR may play a role in the physiology of the innervation of the gastro-intestinal tract. The presence of dysfunctional CFTRs in enteric ganglia could, to a certain extent, explain the gastrointestinal symptoms frequently experienced by CF patients.
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Affiliation(s)
- Ruiqi Xue
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Huan Gu
- Department of Pathology, Key Laboratory of Infectious Diseases and Molecular Pathology, Guangdong Province, Collaborative and Creative Center of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou, China
- Department of Physics, University of Maryland, College Park, MD, USA
| | - Yamei Qiu
- Department of Pathology, Key Laboratory of Infectious Diseases and Molecular Pathology, Guangdong Province, Collaborative and Creative Center of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou, China
| | - Yong Guo
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Christine Korteweg
- Department of Pathology, Key Laboratory of Infectious Diseases and Molecular Pathology, Guangdong Province, Collaborative and Creative Center of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou, China
| | - Jin Huang
- Department of Pathology, Key Laboratory of Infectious Diseases and Molecular Pathology, Guangdong Province, Collaborative and Creative Center of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou, China
| | - Jiang Gu
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Department of Pathology, Key Laboratory of Infectious Diseases and Molecular Pathology, Guangdong Province, Collaborative and Creative Center of Molecular Pathology and Personalized Medicine, Shantou University Medical College, Shantou, China
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Abstract
The diagnosis of cystic fibrosis (CF) has evolved over the past decade as newborn screening has become universal in the United States and elsewhere. The heterogeneity of phenotypes associated with CF transmembrane conductance regulator (CFTR) dysfunction and mutations in the CFTR gene has become clearer, ranging from classic pancreatic-insufficient CF to manifestations in only 1 organ system to indeterminate diagnoses identified by newborn screening. The tools available for diagnosis have also expanded. This article reviews the newest diagnostic criteria for CF, newborn screening, prenatal screening and diagnosis, and indeterminate diagnoses in newborn-screened infants and symptomatic adults.
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Furlan LL, Marson FAL, Ribeiro JD, Bertuzzo CS, Salomão Junior JB, Souza DRS. IL8 gene as modifier of cystic fibrosis: unraveling the factors which influence clinical variability. Hum Genet 2016; 135:881-94. [PMID: 27209008 DOI: 10.1007/s00439-016-1684-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/14/2016] [Indexed: 12/31/2022]
Abstract
The severity of cystic fibrosis (CF) is associated with classes of mutations in the CFTR gene (cystic fibrosis transmembrane regulator), physical environment and modifier genes interaction. The IL8 gene (interleukin 8), according to its respective polymorphisms, influences inflammatory responses. This study analyzed IL8 gene polymorphisms (rs4073, rs2227306 and rs2227307), by means of PCR/RFLP, and their association with pulmonary function markers and clinical severity scores in 186 patients with CF, considering the CFTR genotype. There was an association between rs2227307 and precocity of the disease. The severity of lung disease was associated with the following markers: transcutaneous arterial hemoglobin oxygen saturation (SaO2) (regardless of CFTR genotype, for the polymorphisms rs4073, rs2227306 and rs2227307); mucoid Pseudomonas aeruginosa (regardless of CFTR genotype, for the polymorphisms rs2227306 and rs2227307). Pulmonary function markers (SaO2 and spirometric variables) and clinical severity scores were also associated with IL8 gene polymorphisms. This study identified the IL8 gene, represented by rs4073 and rs2227306 polymorphisms, and particularly the rs2227307 polymorphism, as potentiating factors for the degree of variability in the severity of CF, especially in pulmonary clinical manifestation correlated with increased morbidity and mortality.
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Affiliation(s)
- Larissa Lazzarini Furlan
- Medical School of São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, Vila São José, São José do Rio Preto, São Paulo, CEP 15090-000, Brazil
| | - Fernando Augusto Lima Marson
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP 13083-887, Brazil.
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP 13083-887, Brazil.
| | - José Dirceu Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP 13083-887, Brazil
| | - Carmen Sílvia Bertuzzo
- Department of Medical Genetics, School of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, CEP 13083-887, Brazil
| | - João Batista Salomão Junior
- Department of Pediatrics and Department of Pediatrics Pneumology, University Hospital, Medical School of São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, Vila São José, São José do Rio Preto, São Paulo, CEP 15090-000, Brazil
| | - Dorotéia Rossi Silva Souza
- Department of Molecular Biology, Research Center for Biochemistry and Molecular Biology, Medical School of São José do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, Vila São José, São José do Rio Preto, São Paulo, CEP 15090-000, Brazil
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Cystic fibrosis and the war for iron at the host-pathogen battlefront. Proc Natl Acad Sci U S A 2016; 113:1480-2. [PMID: 26802119 DOI: 10.1073/pnas.1525101113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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