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Olivença DV, Davis JD, Kumbale CM, Zhao CY, Brown SP, McCarty NA, Voit EO. Mathematical models of cystic fibrosis as a systemic disease. WIREs Mech Dis 2023; 15:e1625. [PMID: 37544654 PMCID: PMC10843793 DOI: 10.1002/wsbm.1625] [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: 12/16/2022] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
Cystic fibrosis (CF) is widely known as a disease of the lung, even though it is in truth a systemic disease, whose symptoms typically manifest in gastrointestinal dysfunction first. CF ultimately impairs not only the pancreas and intestine but also the lungs, gonads, liver, kidneys, bones, and the cardiovascular system. It is caused by one of several mutations in the gene of the epithelial ion channel protein CFTR. Intense research and improved antimicrobial treatments during the past eight decades have steadily increased the predicted life expectancy of a person with CF (pwCF) from a few weeks to over 50 years. Moreover, several drugs ameliorating the sequelae of the disease have become available in recent years, and notable treatments of the root cause of the disease have recently generated substantial improvements in health for some but not all pwCF. Yet, numerous fundamental questions remain unanswered. Complicating CF, for instance in the lung, is the fact that the associated insufficient chloride secretion typically perturbs the electrochemical balance across epithelia and, in the airways, leads to the accumulation of thick, viscous mucus and mucus plaques that cannot be cleared effectively and provide a rich breeding ground for a spectrum of bacterial and fungal communities. The subsequent infections often become chronic and respond poorly to antibiotic treatments, with outcomes sometimes only weakly correlated with the drug susceptibility of the target pathogen. Furthermore, in contrast to rapidly resolved acute infections with a single target pathogen, chronic infections commonly involve multi-species bacterial communities, called "infection microbiomes," that develop their own ecological and evolutionary dynamics. It is presently impossible to devise mathematical models of CF in its entirety, but it is feasible to design models for many of the distinct drivers of the disease. Building upon these growing yet isolated modeling efforts, we discuss in the following the feasibility of a multi-scale modeling framework, known as template-and-anchor modeling, that allows the gradual integration of refined sub-models with different granularity. The article first reviews the most important biomedical aspects of CF and subsequently describes mathematical modeling approaches that already exist or have the potential to deepen our understanding of the multitude aspects of the disease and their interrelationships. The conceptual ideas behind the approaches proposed here do not only pertain to CF but are translatable to other systemic diseases. This article is categorized under: Congenital Diseases > Computational Models.
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Affiliation(s)
- Daniel V. Olivença
- Center for Engineering Innovation, The University of Texas at Dallas, 800 W. Campbell Road, Richardson, Texas 75080, USA
| | - Jacob D. Davis
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
| | - Carla M. Kumbale
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
| | - Conan Y. Zhao
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Samuel P. Brown
- Department of Biological Sciences, Georgia Tech and Emory University, Atlanta, Georgia
| | - Nael A. McCarty
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eberhard O. Voit
- Department of Biomedical Engineering, Georgia Tech and Emory University, Atlanta, Georgia
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Rowe CA, Wright CF. Expanded universal carrier screening and its implementation within a publicly funded healthcare service. J Community Genet 2019; 11:21-38. [PMID: 31828606 PMCID: PMC6962405 DOI: 10.1007/s12687-019-00443-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022] Open
Abstract
Carrier screening, a well-established clinical initiative, has been slow to take advantage of the new possibilities offered by high-throughput next generation sequencing technologies. There is evidence of significant benefit in expanding carrier screening to include multiple autosomal recessive conditions and offering a ‘universal’ carrier screen that could be used for a pan-ethnic population. However, the challenges of implementing such a programme and the difficulties of demonstrating efficacy worthy of public health investment are significant barriers. In order for such a programme to be successful, it would need to be applicable and acceptable to the population, which may be ethnically and culturally diverse. There are significant practical and ethical implications associated with determining which variants, genes and conditions to include whilst maintaining adequate sensitivity and accuracy. Although preconception screening would maximise the potential benefits from universal carrier screening, the resource implications of different modes of delivery need to be carefully evaluated and balanced against maximising reproductive autonomy and ensuring equity of access. Currently, although a number of existing initiatives are increasing access to carrier screening, there is insufficient evidence to inform the development of a publicly funded, expanded, universal carrier screening programme that would justify investment over other healthcare interventions.
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Affiliation(s)
- Charlotte A Rowe
- University of Exeter, St Luke's Campus, 79 Heavitree Rd, Exeter, EX1 1TX, UK. .,Post Graduate Centre, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, Cornwall, TR1 3LQ, UK.
| | - Caroline F Wright
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, RILD Building, RD&E, Barrack Road, Exeter, EX2 5DW, UK.
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Bilkey GA, Burns BL, Coles EP, Bowman FL, Beilby JP, Pachter NS, Baynam G, J. S. Dawkins H, Nowak KJ, Weeramanthri TS. Genomic Testing for Human Health and Disease Across the Life Cycle: Applications and Ethical, Legal, and Social Challenges. Front Public Health 2019; 7:40. [PMID: 30915323 PMCID: PMC6421958 DOI: 10.3389/fpubh.2019.00040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/14/2019] [Indexed: 12/23/2022] Open
Abstract
The expanding use of genomic technologies encompasses all phases of life, from the embryo to the elderly, and even the posthumous phase. In this paper, we present the spectrum of genomic healthcare applications, and describe their scope and challenges at different stages of the life cycle. The integration of genomic technology into healthcare presents unique ethical issues that challenge traditional aspects of healthcare delivery. These challenges include the different definitions of utility as applied to genomic information; the particular characteristics of genetic data that influence how it might be protected, used and shared; and the difficulties applying existing models of informed consent, and how new consent models might be needed.
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Affiliation(s)
- Gemma A. Bilkey
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Belinda L. Burns
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Emily P. Coles
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Faye L. Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - John P. Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Nicholas S. Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Gareth Baynam
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Centre for Child Health Research, The University of Western Australia and Telethon Kids Institute, Perth, WA, Australia
| | - Hugh J. S. Dawkins
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA, Australia
- School of Public Health, Curtin University of Technology, Bentley, WA, Australia
| | - Kristen J. Nowak
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
| | - Tarun S. Weeramanthri
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
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Holtkamp KCA, Henneman L, Gille JJP, Meijers-Heijboer H, Cornel MC, Lakeman P. Direct-to-consumer carrier screening for cystic fibrosis via a hospital website: a 6-year evaluation. J Community Genet 2018; 10:249-257. [PMID: 30229537 PMCID: PMC6435772 DOI: 10.1007/s12687-018-0388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
Abstract
A Dutch university hospital started offering cystic fibrosis (CF) carrier screening directly to consumers (DTC) through their website in 2010. A 6-year process evaluation was conducted to evaluate the offer. Screening was implemented as intended. However, uptake was lower than expected. Forty-four tests have been requested, partly by couples with a positive family history for CF, which was not the intended target group. Users were generally positive about the screening offer, citing accessibility, ease of testing, anonymity, and perceived shortcomings of regular healthcare as reasons for requesting screening. DTC CF carrier screening via a university hospital website is feasible, but is seldom used. Considering technological advances, continuation of this specific offer is questionable.
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Affiliation(s)
- Kim C A Holtkamp
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Johan J P Gille
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Hanne Meijers-Heijboer
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
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Anıl H, Kılıç Yıldırım G, Harmancı K, Bozkurt Turhan A, Akay OM, Bör Ö, Aydoğdu S, Kocak A. Thromboelastogram as a Tool to Predict Hypercoagulability in Children With Cystic Fibrosis. Clin Appl Thromb Hemost 2016; 24:348-352. [PMID: 28030968 DOI: 10.1177/1076029616683045] [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] [Indexed: 11/15/2022] Open
Abstract
Increased thrombophilic tendency in patients with cystic fibrosis (CF) has recently been reported. The determinants of thrombosis in children with CF remain largely unknown. Our aim in this study was to evaluate the thromboelastography (TEG) profile of children with CF through ROTEM (whole blood rotation thromboelastometry). Nineteen patients with CF and 20 controls were included in the study. Whole blood count, prothrombin time, activated prothrombin time, fibrinogen, d-dimer levels, and ROTEM assays (INTEM, EXTEM) were performed. Clotting time, clot formation time (CFT), and maximum clot firmness (MCF) were determined by INTEM and EXTEM analysis. In INTEM assay, MCF ( P = .001) value was significantly increased and CFT ( P = .031) value was decreased in patients with CF compared with those of the control group. In the EXTEM assay, there was a similar significant increase in MCF ( P = .023) value in patients with CF compared with that of the control group. There was a significant positive correlation between fibrinogen levels and MCF in EXTEM ( r = .72) and INTEM ( r = .76) assays, whereas there was a negative correlation with CFT in EXTEM ( r = -.61) and INTEM ( r = -.67). The results of our study indicated that TEG profiles in patients with CF were more hypercoagulable compared with those of the control group.
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Affiliation(s)
- Hülya Anıl
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Gonca Kılıç Yıldırım
- 2 Department of Pediatric Nutrition and Metabolism, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Koray Harmancı
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Ayşe Bozkurt Turhan
- 3 Department of Pediatric Hematology and Oncology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Olga Meltem Akay
- 4 Department of Hematology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Özcan Bör
- 3 Department of Pediatric Hematology and Oncology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Sultan Aydoğdu
- 2 Department of Pediatric Nutrition and Metabolism, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Abdulkadır Kocak
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Young AJ. Breathe. HEALTH COMMUNICATION 2016; 31:1174-1177. [PMID: 26797013 DOI: 10.1080/10410236.2015.1032852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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