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Hu R, Wu F, Zheng YQ. Ivacaftor attenuates gentamicin-induced ototoxicity through the CFTR-Nrf2-HO1/NQO1 pathway. Redox Rep 2024; 29:2332038. [PMID: 38563333 PMCID: PMC10993751 DOI: 10.1080/13510002.2024.2332038] [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: 04/04/2024] Open
Abstract
OBJECTIVES Gentamicin is one of the most common ototoxic drugs that can lower patients' quality of life. Oxidative stress is a key factors inducing sensory hair cell death during gentamicin administration. So far, there are no effective drugs to prevent or treat gentamicin- induced hearing loss. A recent study found cystic fibrosis transmembrane conductance regulator (CFTR) as a new target to modulate cellular oxidative balance. The objective of this study was to estimate the effect of the CFTR activator ivacaftor on gentamicin-induced ototoxicity and determine its mechanism. METHODS The hair cell count was analyzed by Myosin 7a staining. Apoptosis was analyzed by TUNEL Apoptosis Kit. Cellular reactive oxygen species (ROS) level was detected by DCFH-DA probes. The Nrf2 related proteins expression levels were analyzed by western blot. RESULTS An in vitro cochlear explant model showed that gentamicin caused ROS accumulation in sensory hair cells and induced apoptosis, and this effect was alleviated by pretreatment with ivacaftor. Western blotting showed that ivacaftor administration markedly increased the protein expression of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO1), and NAD(P)H:quinone oxidoreductase 1 (NQO1). The protective effect of ivacaftor was abolished by the Nrf2 inhibitor ML385. DISCUSSION Our results indicate the protective role of the CFTR-Nrf2-HO1/NQO1 pathway in gentamicin-induced ototoxicity. Ivacaftor may be repositioned or repurposed towards aminoglycosides-induced hearing loss.
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Affiliation(s)
- Rui Hu
- Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei, People’s Republic of China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Fan Wu
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Pathology and Laboratory Medicine, The Medical University of South Carolina, Charleston, SC, USA
| | - Yi-Qing Zheng
- Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei, People’s Republic of China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Barreca M, Renda M, Spanò V, Montalbano A, Raimondi MV, Giuffrida S, Bivacqua R, Bandiera T, Galietta LJV, Barraja P. Identification of 6,9-dihydro-5H-pyrrolo[3,2-h]quinazolines as a new class of F508del-CFTR correctors for the treatment of cystic fibrosis. Eur J Med Chem 2024; 276:116691. [PMID: 39089001 DOI: 10.1016/j.ejmech.2024.116691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 08/03/2024]
Abstract
Although substantial advances have been obtained in the pharmacological treatment of cystic fibrosis (CF) with the approval of Kaftrio, a combination of two correctors (VX-661, VX-445) and one potentiator (VX-770), new modulators are still needed to rescue F508del and other CFTR mutants with trafficking defects. We have previously identified PP compounds based on a tricyclic core as correctors with high efficacy in the rescue of F508del-CFTR on native epithelial cells of CF patients, particularly in combination with class 1 correctors (VX-809, VX-661). Compound PP028 was found as a lead candidate for the high rescue of F508del-CFTR and used for mechanistic insight indicating that PP028 behaves as a class 3 corrector, similarly to VX-445. From the exploration of the chemical space around the hit structure, based on iterative cycles of chemical synthesis and functional testing, the class of 6,9-dihydro-5H-pyrrolo [3,2-h]quinazolines with corrector activity was discovered. Within a series of 38 analogues, two derivatives emerged as promising candidates and used for further insight to assess the mechanism of action. Both compounds, decorated with a benzensulfonylamino group at the pyrimidine moiety, were able to generate a dose-dependent increase in CFTR function, particularly in the presence of VX-809. Half-effective concentrations (EC50) were in the single digit micromolar range and decreased in the presence of VX-809 thus indicating a synergistic interaction with class 1 correctors. Synergy was also observed with corr-4a (class 2 corrector) but not with VX-445 and PP028 (class 3 correctors) indicating that the new compounds behave as class 3 correctors. These results suggest that tricyclic pyrrolo-quinazolines interact with CFTR at a site different from that of VX-809 and represent a novel class of CFTR correctors suitable for combinatorial pharmacological treatments for the basic defect in CF.
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Affiliation(s)
- Marilia Barreca
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Mario Renda
- Telethon Institute of Genetics and Medicine (TIGEM), Via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy
| | - Virginia Spanò
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Alessandra Montalbano
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Maria Valeria Raimondi
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Stefano Giuffrida
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Roberta Bivacqua
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy
| | - Tiziano Bandiera
- D3 PharmaChemistry, Istituto Italiano di Tecnologia (IIT), Via Morego 30, 16163 Genova, Italy
| | - Luis J V Galietta
- Telethon Institute of Genetics and Medicine (TIGEM), Via Campi Flegrei 34, 80078 Pozzuoli, NA, Italy; Department of Translational Medical Sciences (DISMET), University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Paola Barraja
- Department of Biological, Chemical, and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Via Archirafi 32, 90123 Palermo, Italy.
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Roesch EA, Rahmaoui A, Lazarus RA, Konstan MW. The continuing need for dornase alfa for extracellular airway DNA hydrolysis in the era of CFTR modulators. Expert Rev Respir Med 2024:1-16. [PMID: 39176450 DOI: 10.1080/17476348.2024.2394694] [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: 04/26/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION The availability of cystic fibrosis transmembrane conductance regulator (CFTR) modulators opens the possibility of discontinuing some chronic pulmonary therapies to decrease cystic fibrosis (CF) treatment burden. However, CFTR modulators may not adequately address neutrophilic inflammation, which contributes to a self-perpetual cycle of viscous CF sputum, airway obstruction, inflammation, and lung function decline. AREAS COVERED This review discusses the emerging role of neutrophil extracellular traps in CF and its role in CF sputum viscosity, airway obstruction, and inflammation, based on a literature search of PubMed (1990-present). We summarize clinical trials and real-world studies that support the efficacy of dornase alfa (Pulmozyme) in improving lung function and reducing pulmonary exacerbation in people with CF (PwCF), and we discuss the potential role of dornase alfa in reducing airway inflammation. We also examine the findings of short-term trials evaluating the discontinuation of mucoactive therapy in PwCF receiving CFTR modulators. EXPERT OPINION Long-term studies are needed to assess the impact of discontinuing mucoactive therapy in PwCF who are clinically stable while receiving CFTR modulatory therapy. Treatment decisions should take into account the severity of underlying lung disease. People with advanced CF will likely require ongoing mucoactive therapy.
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Affiliation(s)
- Erica A Roesch
- Department of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, OH, USA
| | | | - Robert A Lazarus
- Departments of Biological Chemistry and Early Discovery Biochemistry, Genentech, Inc., South San Francisco, CA, USA
| | - Michael W Konstan
- Department of Pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, OH, USA
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Mooney R, Richardson K, Rodgers K, Giammarini E, Williams R, Kelly S, Amaeze N, Inkster T, Henriquez FL, Mackay W. Acanthamoeba as a protective reservoir for Pseudomonas aeruginosa in a clinical environment. J Hosp Infect 2024:S0195-6701(24)00291-3. [PMID: 39218354 DOI: 10.1016/j.jhin.2024.08.010] [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: 05/09/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Pseudomonas aeruginosa is a growing concern in healthcare associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as Acanthamoeba play in the detection, disinfection, and transmission of P. aeruginosa. P. aeruginosa can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas. Herein, we have screened for the presence of Acanthamoeba species and P. aeruginosa within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a 4-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed amoebae harbour a unique microbial community comprised primarily of Pseudomonas species that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between Acanthamoeba and P. aeruginosa in the laboratory, showing that i) Acanthamoeba growth rate is increased in the presence of Pseudomonas biofilms and viable Pseudomonas persist within the amoebae and ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of P. aeruginosa in the presence of Acanthamoeba than when the bacteria are incubated alone. These findings suggest that amoebae, and other protists, can influence the detection and persistence of P. aeruginosa in high-risk areas and should be considered when implementing mitigation strategies.
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Affiliation(s)
- Ronnie Mooney
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Kenny Richardson
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Kiri Rodgers
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Elisa Giammarini
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Roderick Williams
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Steven Kelly
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Ngozi Amaeze
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - Teresa Inkster
- Antimicrobial Resistance & Healthcare Associated Infection (ARHAI) Scotland, Delta House, 48 West Nile Street, Glasgow, United Kingdom
| | - Fiona L Henriquez
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom
| | - William Mackay
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, United Kingdom.
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Fainardi V, Cresta F, Sorio C, Melotti P, Pesce E, Deolmi M, Longo F, Karina K, Esposito S, Pisi G. Elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis and rare mutations. Pediatr Pulmonol 2024. [PMID: 39212240 DOI: 10.1002/ppul.27211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/16/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The triple combination of elexacaftor/tezacaftor/ivacaftor (ETI) has dramatically improved the outcome of people with Cystic Fibrosis (pwCF) with at least one F508del mutation. However, carriers of rare cystic fibrosis transmembrane conductance regulator (CFTR) variants are not candidates for this innovative treatment. METHODS In this observational study, we report the results of the compassionate use of ETI in 10 pwCF carriers of rare mutations after 2 months of treatment. Rectal organoids and short-term cultures of nasal epithelium obtained from rectal suction biopsies and nasal brushing were obtained from four subjects. RESULTS After 2 months of ETI, all patients (4 males, mean age 30.1 ± 13.3 years) showed a significant increase of FEV1% predicted values [+8.0 (3.5-12.7) %, p < 0.010], body mass index [+0.85 (0-1.22) kg/m2, p < 0.020] and cystic fibrosis questionnaire-revised [+19.5 (6.3-29.2) points, p < 0.009]. A significant decrease of sweat chloride concentration [-11.2 (-1.7 to -34.0) mmol/L, p < 0.020] and exacerbations [-1.5 (-2 to -1), p < 0.008] was also recorded. Overall, 7 out of 10 participants were considered full responders. All patients reported cough disappearance (n = 3) or reduction (n = 7). Long-term oxygen was discontinued in two out of three patients and one also stopped noninvasive ventilation and was removed from the lung transplantation waiting list. CONCLUSIONS Despite the limited number of cases, our results support the use of CFTR modulators in patients with rare CFTR variants that are not currently approved for ETI in Europe.
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Affiliation(s)
- Valentina Fainardi
- Department of Medicine and Surgery, Cystic Fibrosis Unit, Pediatric Clinic, Parma, Italy
| | - Federico Cresta
- UOSD Centro Fibrosi Cistica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudio Sorio
- Cystic Fibrosis Laboratory D. Lissandrini, Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Paola Melotti
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Emanuela Pesce
- IRCCS Istituto Giannina Gaslini, UOC Genetica Medica, Genova, Italy
| | - Michela Deolmi
- Cystic Fibrosis Unit, Pediatric Clinics, University Hospital of Parma, Parma, Italy
| | - Francesco Longo
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, Parma, Italy
| | - Kleinfelder Karina
- Cystic Fibrosis Laboratory D. Lissandrini, Department of Medicine, Division of General Pathology, University of Verona, Verona, Italy
| | - Susanna Esposito
- Department of Medicine and Surgery, Cystic Fibrosis Unit, Pediatric Clinic, Parma, Italy
| | - Giovanna Pisi
- Cystic Fibrosis Unit, Pediatric Clinics, University Hospital of Parma, Parma, Italy
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Martens DS, Lammertyn EJ, Goeminne PC, Colpaert K, Proesmans M, Vanaudenaerde BM, Nawrot TS, Dupont LJ. Leukocyte telomere length and attrition in association with disease severity in cystic fibrosis patients. Aging (Albany NY) 2024; 16:206093. [PMID: 39213174 DOI: 10.18632/aging.206093] [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: 12/19/2023] [Accepted: 07/15/2024] [Indexed: 09/04/2024]
Abstract
Cystic fibrosis (CF) is characterized by chronic airway inflammation and premature aging. The link with leukocyte telomere length (LTL) as a marker of biological aging is unclear. We studied disease severity and LTL in 168 CF patients of which 85 patients had a second retrospective LTL assessment. A higher FEV1 was associated with longer LTL, with a stronger effect in men (5.08% longer LTL) compared to women (0.41% longer LTL). A higher FEV1/FVC ratio was associated with 7.05% (P=0.017) longer LTL in men. CF asthma, as defined by the treatment with inhaled corticosteroids, was associated with -6.65% shorter LTL (P=0.028). Men homozygous for the ΔF508 genotype showed a -10.48% (P=0.026) shorter LTL compared to heterozygotes. A genotype-specific non-linear association between LTL shortening and chronological age was observed. Stronger age-related LTL shortening was observed in patients homozygous for the ΔF508 genotype (P-interaction= 0.044). This work showed that disease severity in CF patients negatively influences LTL, with slightly more pronounced effects in men. The homozygous genotype for ΔF508 may play a role in LTL attrition in CF patients. Understanding factors in CF patients that accelerate biological aging provides insights into mechanisms that can extend the overall life quality in CF-diseased.
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Affiliation(s)
- Dries S Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Elise J Lammertyn
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Kristine Colpaert
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Flanders, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Lieven J Dupont
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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Mazzocato P, Luckhaus JL, Malmqvist Castillo M, Burnett J, Hager A, Oates G, Wannheden C, Savage C. A Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study. J Med Internet Res 2024; 26:e50527. [PMID: 39083342 PMCID: PMC11325108 DOI: 10.2196/50527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 04/08/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective. OBJECTIVE The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics. METHODS A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9%, in Sweden; n=1, 11.1%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis. RESULTS We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16%-23%), middle (25%-47%), or high (58%-95%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability. CONCLUSIONS For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers' perspectives on what generates value is essential.
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Affiliation(s)
- Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Södertälje Hospital, Södertälje, Sweden
| | - Jamie Linnea Luckhaus
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Participatory e-Health and Health Data, Department of Women's and Child's Health, Uppsala University, Uppsala, Sweden
| | - Moa Malmqvist Castillo
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Gabriela Oates
- Pulmonary, Allergy and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Ladune R, Hayotte M, Vuillemin A, d'Arripe-Longueville F. Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals. JMIR Form Res 2024; 8:e54322. [PMID: 39078689 PMCID: PMC11322687 DOI: 10.2196/54322] [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: 11/06/2023] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. OBJECTIVE This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. METHODS This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. RESULTS In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO_BALAD, designed for people with CF aged ≥18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. CONCLUSIONS This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study.
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Affiliation(s)
- Raphaelle Ladune
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Meggy Hayotte
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Anne Vuillemin
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
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Boni A, Cristiani L, Majo F, Ullmann N, Esposito M, Supino MC, Tomà P, Villani A, Musolino AM, Cutrera R. Use of Lung Ultrasound in Cystic Fibrosis: Is It a Valuable Tool? CHILDREN (BASEL, SWITZERLAND) 2024; 11:917. [PMID: 39201852 PMCID: PMC11352880 DOI: 10.3390/children11080917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024]
Abstract
Cystic fibrosis (CF) is a multisystem disorder characterized by progressive respiratory deterioration, significantly impacting both quality of life and survival. Over the years, lung ultrasound (LUS) has emerged as a promising tool in pediatric respiratory due to its safety profile and ease at the bedside. In the era of highly effective CF modulator therapies and improved life expectancy, the use of non-ionizing radiation techniques could become an integral part of CF management, particularly in the pediatric population. The present review explores the potential role of LUS in CF management based on available data, analyzing all publications from January 2015 to January 2024, focusing on two key areas: LUS in CF pulmonary exacerbation and its utility in routine clinical management. Nonetheless, LUS exhibits a robust correlation with computed tomography (CT) scans and serves as an additional, user-friendly imaging modality in CF management, demonstrating high specificity and sensitivity in identification, especially in consolidations and atelectasis in the CF population. Due to its ability, LUS could be an instrument to monitor exacerbations with consolidations and to establish therapy duration and monitor atelectasis over time or their evolution after therapeutic bronchoalveolar lavage. On the basis of our analysis, sufficient data emerged showing a good correlation between LUS score and respiratory function tests. Good sensitivity and specificity of the methodology have been found in rare CF pulmonary complications such as effusion and pneumothorax. Regarding its use in follow-up management, the literature reports a moderate correlation between LUS scores and the type, extent, and CT severity score of bronchiectasis. A future validation of ultrasound scores specifically in CF patients could improve the use of LUS to identify pulmonary exacerbations and monitor disease progression. However, further research is needed to comprehensively establish the role of LUS in the CF population, particularly in elucidating its broader utility and long-term impact on patient care.
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Affiliation(s)
- Alessandra Boni
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.B.); (N.U.); (R.C.)
| | - Luca Cristiani
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.C.); (F.M.); (M.E.); (A.V.)
| | - Fabio Majo
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.C.); (F.M.); (M.E.); (A.V.)
| | - Nicola Ullmann
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.B.); (N.U.); (R.C.)
| | - Marianna Esposito
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.C.); (F.M.); (M.E.); (A.V.)
| | - Maria Chiara Supino
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.C.); (F.M.); (M.E.); (A.V.)
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Anna Maria Musolino
- Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Renato Cutrera
- Pneumology and Cystic Fibrosis Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.B.); (N.U.); (R.C.)
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10
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Malmivaara K, Pölkki M, Prami T, Raittinen P, Heikkilä E, Aalto A, Dunder T, Elenius V, Sandström K, McGarry LJ. Cystic fibrosis patient characteristics and healthcare resource utilization in Finland using linked registries. Heliyon 2024; 10:e33439. [PMID: 39040318 PMCID: PMC11261030 DOI: 10.1016/j.heliyon.2024.e33439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 06/14/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Background Knowledge of prevalence and epidemiology of cystic fibrosis (CF) and healthcare resource use among Finnish people with CF is incomplete. Methods We conducted a population-based matched cohort study using retrospective real-world data from linked Finnish national registries. Electronic healthcare data and drug purchases of 102 people with CF were analyzed between January 2015 and December 2019 (follow-up). A 5-fold control population was matched by sex, age, and place of residence. Comorbidities and medication use that occurred at any time during follow-up were assessed; annual rates of hospital service use were adjusted for follow-up. Results The prevalence of CF in Finland was 1.85 per 100,000. Median age at diagnosis was 1 year, with 60 % diagnosed at age <2 years and 80 % at age <10 years. Median age at death in people with CF was 31.4 years (n < 5); no controls died. The most common comorbidities included chronic sinusitis (39.2 %), pneumonia (38.2 %), diabetes (20.6 %), and nasal polyps (18.6 %). The most purchased medications were antibiotics (99.0 %) and pancreatic enzymes (84.3 %). The annualized rate of hospital visits was higher in people with CF vs controls (outpatient: mean [SD], 17.4 [14.5] vs 0.9 [3.3]; median, 13.6 vs 0.4, respectively; inpatient: mean [SD], 1.0 [1.66] vs 0.03 [0.14]; median, 0.34 vs 0, respectively). Conclusions The prevalence of CF in Finland is remarkably low, likely reflecting unique population characteristics and, in part, delayed diagnosis. Antibiotic use is frequent among Finnish people with CF. Inpatient hospital visits are >30 times higher in people with CF than matched controls.
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11
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Sousa AA, Hemez C, Lei L, Traore S, Kulhankova K, Newby GA, Doman JL, Oye K, Pandey S, Karp PH, McCray PB, Liu DR. Systematic optimization of prime editing for the efficient functional correction of CFTR F508del in human airway epithelial cells. Nat Biomed Eng 2024:10.1038/s41551-024-01233-3. [PMID: 38987629 DOI: 10.1038/s41551-024-01233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/12/2024] [Indexed: 07/12/2024]
Abstract
Prime editing (PE) enables precise and versatile genome editing without requiring double-stranded DNA breaks. Here we describe the systematic optimization of PE systems to efficiently correct human cystic fibrosis (CF) transmembrane conductance regulator (CFTR) F508del, a three-nucleotide deletion that is the predominant cause of CF. By combining six efficiency optimizations for PE-engineered PE guide RNAs, the PEmax architecture, the transient expression of a dominant-negative mismatch repair protein, strategic silent edits, PE6 variants and proximal 'dead' single-guide RNAs-we increased correction efficiencies for CFTR F508del from less than 0.5% in HEK293T cells to 58% in immortalized bronchial epithelial cells (a 140-fold improvement) and to 25% in patient-derived airway epithelial cells. The optimizations also resulted in minimal off-target editing, in edit-to-indel ratios 3.5-fold greater than those achieved by nuclease-mediated homology-directed repair, and in the functional restoration of CFTR ion channels to over 50% of wild-type levels (similar to those achieved via combination treatment with elexacaftor, tezacaftor and ivacaftor) in primary airway cells. Our findings support the feasibility of a durable one-time treatment for CF.
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Affiliation(s)
- Alexander A Sousa
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Colin Hemez
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Lei Lei
- Stead Family Department of Pediatrics and Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Soumba Traore
- Stead Family Department of Pediatrics and Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Katarina Kulhankova
- Stead Family Department of Pediatrics and Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Gregory A Newby
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jordan L Doman
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Keyede Oye
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Smriti Pandey
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Philip H Karp
- Department of Internal Medicine and Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
- Howard Hughes Medical Institute, University of Iowa, Iowa City, IA, USA
| | - Paul B McCray
- Stead Family Department of Pediatrics and Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - David R Liu
- Merkin Institute of Transformative Technologies in Healthcare, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA.
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA.
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12
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Emiralioğlu N, Çakır B, Sertçelik A, Yalçın E, Kiper N, Şen V, Altıntaş DU, Serbes M, Çokuğraş H, Kılınç AA, Başkan AK, Hepkaya E, Yazan H, Türel Ö, Kafi HM, Yılmaz Aİ, Ünal G, Çağlar T, Damadoğlu E, Irmak İ, Demir E, Öztürk G, Bingöl A, Başaran E, Sapan N, Aslan AT, Asfuroğlu P, Harmancı K, Köse M, Hangül M, Özdemir A, Tuğcu G, Polat SE, Özcan G, Gayretli ZG, Keskin Ö, Bilgiç S, Yüksel H, Özdoğan Ş, Topal E, Çaltepe G, Can D, Ekren PK, Kılıç M, Süleyman A, Eyüboğlu TŞ, Cinel G, Pekcan S, Çobanoğlu N, Çakır E, Özçelik U, Doğru D. Factors associated with pulmonary function decline of patients in the cystic fibrosis registry of Turkey: A retrospective cohort study. Pediatr Pulmonol 2024. [PMID: 38980199 DOI: 10.1002/ppul.27165] [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: 09/24/2023] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The decline in pulmonary function is a predictor of disease progression in patients with cystic fibrosis (CF). This study aimed to determine the decline rate of percent predicted forced expiratory volume in 1 s (ppFEV1) based on the data of the CF Registry of Turkey. The secondary aim was to investigate the risk factors related to the decline in ppFEV1. METHODS A retrospective cohort study of CF patients over 6 years old, with pulmonary function data over at least 2 years of follow-up was extracted from the national CF registry for years 2017-2019. Patients were classified according to disease severity and age groups. Multivariate analysis was used to predict the decline in ppFEV1 and to investigate the associated risk factors. RESULTS A total of 1722 pulmonary function test results were available from 574 patients over the study period. Mean diagnostic age was older and weight for age, height for age, and body mass index z scores were significantly lower in the group of ppFEV1 < 40, while chronic Pseudomonas aeruginosa (p < .001) and mucoid P. aeruginosa colonization (p < .001) were significantly higher in this group (p < .001). Overall mean annual ppFEV1 decline was -0.97% (95% confidence interval [CI] = -0.02 to -1.92%). The mean change of ppFEV1 was significantly higher in the group with ppFEV1 ≥ 70 compared with the other (ppFEV1 < 40 and ppFEV1: 40-69) two groups (p = .004). Chronic P. aeruginosa colonization (odds ratio [OR] = 1.79 95% CI = 1.26-2.54; p = .01) and initial ppFEV1 ≥ 70 (OR = 2.98 95% CI = 1.06-8.36), p = .038) were associated with significant ppFEV1 decline in the whole cohort. CONCLUSIONS This data analysis recommends close follow-up of patients with normal initial ppFEV1 levels at baseline; advocates for early interventions for P. aeruginosa; and underlines the importance of nutritional interventions to slow down lung disease progression.
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Affiliation(s)
- Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Banu Çakır
- Department of Public Health, Division of Epidemiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Sertçelik
- Department of Public Health, Division of Epidemiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Velat Şen
- Department of Pediatric Pulmonology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Derya Ufuk Altıntaş
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mahir Serbes
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Azer Kılıç Başkan
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Evrim Hepkaya
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Özden Türel
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Hale Molla Kafi
- Department of Pediatric Pulmonology, Bezmi Alem University Faculty of Medicine, İstanbul, Turkey
| | - Aslı İmran Yılmaz
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Gökçen Ünal
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Tuğçe Çağlar
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Ebru Damadoğlu
- Department of Adult Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlim Irmak
- Department of Adult Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esen Demir
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gökçen Öztürk
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşen Bingöl
- Department of Pediatric Allergy, Immunology and Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erdem Başaran
- Department of Pediatric Allergy, Immunology and Pulmonology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nihat Sapan
- Department of Pediatric Allergy, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ayşe Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Asfuroğlu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Koray Harmancı
- Department of Pediatric Allergy, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Mehmet Köse
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Melih Hangül
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ali Özdemir
- Department of Pediatric Pulmonology, Mersin City Hospital, Mersin, Turkey
| | - Gökçen Tuğcu
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | | | - Gizem Özcan
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Gökçe Gayretli
- Department of Pediatric Infectious Disease, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Özlem Keskin
- Department of Pediatric Allergy and Immunology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Sevgi Bilgiç
- Department of Pediatric Allergy and Immunology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Hasan Yüksel
- Department of Pediatric Allergy, Immunology and Pulmonology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Şebnem Özdoğan
- Department of Pediatric Pulmonology, Sarıyer Hamidiye Etfal Hospital, İstanbul, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy and Immunology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Pervin Korkmaz Ekren
- Department of Adult Pulmonology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mehmet Kılıç
- Department of Pediatric Allergy and Immunology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ayşe Süleyman
- Department of Pediatric Allergy and Immunology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Güzin Cinel
- Department of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, İstinye University Faculty of Medicine, Istanbul, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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Eastman AC, Rosson G, Kim N, Kang S, Raraigh K, Goff LA, Merlo C, Lechtzin N, Cutting GR, Sharma N. Establishment of a conditionally reprogrammed primary eccrine sweat gland culture for evaluation of tissue-specific CFTR function. J Cyst Fibros 2024:S1569-1993(24)00783-5. [PMID: 38969603 DOI: 10.1016/j.jcf.2024.06.013] [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: 02/21/2024] [Revised: 04/30/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Sweat chloride concentration is used both for CF diagnosis and for tracking CFTR modulator efficacy over time, but the relationship between sweat chloride and lung health is heterogeneous and informed by CFTR genotype. Here, we endeavored to characterize ion transport in eccrine sweat glands (ESGs). METHODS First, ESGs were microdissected from a non-CF skin donor to analyze individual glands. We established primary cultures of ESG cells via conditional reprogramming for functional testing of ion transport by short circuit current measurement and examined cell composition by single-cell RNA-sequencing (scRNA-seq) comparing with whole dissociated ESGs. Secondly, we cultured nasal epithelial (NE) cells and ESGs from two people with CF (pwCF) to assess modulator efficacy. Finally, NEs and ESGs were grown from one person with the CFTR genotype F312del/F508del to explore genotype-phenotype heterogeneity. RESULTS ESG primary cells from individuals without CF demonstrated robust ENaC and CFTR function. scRNA-seq demonstrated both secretory and ductal ESG markers in cultured ESG cells. In both NEs and ESGs from pwCF homozygous for F508del, minimal baseline CFTR function was observed, and treatment with CFTR modulators significantly enhanced function. Notably, NEs from an individual bearing F312del/F508del exhibited significant baseline CFTR function, whereas ESGs from the same person displayed minimal CFTR function, consistent with observed phenotype. CONCLUSIONS This study has established a novel primary culture technique for ESGs that allows for functional ion transport measurement to assess modulator efficacy and evaluate genotype-phenoytpe heterogeneity. To our knowledge, this is the first reported application of conditional reprogramming and scRNA-seq of microdissected ESGs.
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Affiliation(s)
- Alice C Eastman
- Johns Hopkins School of Medicine, Department of Human Genetics, Miller Research Building, 733N Broadway, Baltimore, MD 21205, USA
| | - Gedge Rosson
- Johns Hopkins Medicine, Department of Plastic and Reconstructive Surgery, 601N Caroline St, Baltimore, MD 21287, USA
| | - Noori Kim
- Johns Hopkins School of Medicine, Department Medicine, Division of Dermatology, 601N Caroline St, Baltimore, MD 21287, USA
| | - Sewon Kang
- Johns Hopkins School of Medicine, Department Medicine, Division of Dermatology, 601N Caroline St, Baltimore, MD 21287, USA
| | - Karen Raraigh
- Johns Hopkins School of Medicine, Department of Human Genetics, Miller Research Building, 733N Broadway, Baltimore, MD 21205, USA
| | - Loyal A Goff
- Johns Hopkins School of Medicine, Department of Human Genetics, Miller Research Building, 733N Broadway, Baltimore, MD 21205, USA
| | - Christian Merlo
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Noah Lechtzin
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Garry R Cutting
- Johns Hopkins School of Medicine, Department of Human Genetics, Miller Research Building, 733N Broadway, Baltimore, MD 21205, USA
| | - Neeraj Sharma
- Johns Hopkins School of Medicine, Department of Human Genetics, Miller Research Building, 733N Broadway, Baltimore, MD 21205, USA.
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14
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Chen Q, Li J. Molecular mechanism analysis of nontuberculous mycobacteria infection in patients with cystic fibrosis. Future Microbiol 2024; 19:877-888. [PMID: 38700285 PMCID: PMC11290754 DOI: 10.2217/fmb-2023-0237] [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: 10/26/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Aim: This study aims to explore the molecular mechanisms of cystic fibrosis (CF) complicated with nontuberculous mycobacteria (NTM) infection. Materials & methods: Expression profiles of CF with NTM-infected patients were downloaded from GEO database. Intersection analysis yielded 78 genes associated with CF with NTM infection. The protein-protein interaction (PPI) network and the functions of hub genes were investigated. Results: Five hub genes (PIK3R1, IL1A, CXCR4, ACTN1, PFN1) were identified, which were primarily enriched in actin-related biological processes and pathways. Transcription factors RELA, JUN, NFKB1 and FOS that regulated hub genes modulated IL1A expression, while 21 other transcription factors regulated CXCR4 expression. Conclusion: In summary, this study may provide new insights into the mechanisms of CF with NTM infection.
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Affiliation(s)
- Qihuang Chen
- Department of Tuberculosis, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, China
| | - Jin Li
- Department of Tuberculosis, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, China
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15
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Saegebrecht LS, Röhlig M, Schaub F, Ballmann M, Stachs O, Fischer DC. Glycemic Variability and the Thickness of Retinal Layers in Cystic Fibrosis Patients with and without Cystic Fibrosis Related Diabetes. Curr Eye Res 2024; 49:759-767. [PMID: 38557392 DOI: 10.1080/02713683.2024.2333770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Patients with cystic fibrosis (CF) are at risk to develop CF related diabetes (CFRD) and subsequently even diabetic neuro- and/or vasculopathy. We sought to determine if there are typical signs of diabetes-related retinal alterations present in CF patients with preserved and impaired glycemic control. METHODS During routine annual examination CF patients were offered an additional 7-day period of real time continuous glucose monitoring (rtCGM) and an ophthalmological examination including retinal optical coherence tomography (OCT). Patients were categorized according to the glycemic control, i.e. the results of an oral glucose tolerance test (OGTT) and rtCGM were taken into consideration. OCT data was analyzed by our previously published visual analysis software generating dedicated and spatially resolved deviation maps for visualization and quantification of differences in total retinal thickness and thickness of retinal nerve fiber layer (RNFL) as well as ganglion cell layer (GCL) in comparison to age-matched healthy controls and patients with either type 1 or type 2 diabetes mellitus. RESULTS Results of the rtCGM and/or OGTT enabled discrimination between patients with normal glycemic control (CFNG; n = 6), with abnormal glycemic control (CFAG; n = 6) and overt CFRD (n = 4). OCT data indicates gradually increasing retinal thinning in all 3 groups, depending on the degree of glucose metabolism disorder compared to healthy controls. At the foveal region total retinal thickness and GCL thickness were significantly thinner in CFRD patients compared to CFNG patients (total retinal thickness: 260.4 µm (239.3-270.8) vs. 275.4 µm (254.3-289.5); GCL: 11.82 µm (11.16-15.25) vs. 17.30 µm (13.95-19.82); each p < 0.05). CONCLUSION Although we investigated a rather small number of patients, we obtained evidence that intraretinal neurodegenerative changes occur in each of our subgroups (CFNG, CFAG, CFRD). Beyond this, our results favor the detrimental role of additional diabetes, as the deviations from healthy controls were most pronounced in the CFRD group and are similar to those seen in patients suffering from type 1 or type 2 diabetes.
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Affiliation(s)
- Luisa S Saegebrecht
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Martin Röhlig
- Institute of Visual and Analytic Computing, University of Rostock, Rostock, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Manfred Ballmann
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Centre, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
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16
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Sandler RD, Lai L, Dawson S, Cameron S, Lynam A, Sperrin M, Hoo ZH, Wildman MJ. Development of data processing algorithm to calculate adherence for adults with cystic fibrosis using inhaled therapy - a multi-center observational study within the CFHealthHub learning health system. Expert Rev Pharmacoecon Outcomes Res 2024; 24:759-771. [PMID: 38458615 DOI: 10.1080/14737167.2024.2328085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To develop a robust algorithm to accurately calculate 'daily complete dose counts' for inhaled medicines, used in percent adherence calculations, from electronically-captured nebulizer data within the CFHealthHub Learning Health System. METHODS A multi-center, cross-sectional study involved participants and clinicians reviewing real-world inhaled medicine usage records and triangulating them with objective nebulizer data to establish a consensus on 'daily complete dose counts.' An algorithm, which used only objective nebulizer data, was then developed using a derivation dataset and evaluated using internal validation dataset. The agreement and accuracy between the algorithm-derived and consensus-derived 'daily complete dose counts' was examined, with the consensus-derived count as the reference standard. RESULTS Twelve people with CF participated. The algorithm derived a 'daily complete dose count' by screening out 'invalid' doses (those <60s in duration or run in cleaning mode), combining all doses starting within 120s of each other, and then screening out all doses with duration < 480s which were interrupted by power supply failure. The kappa co-efficient was 0.85 (0.71-0.91) in the derivation and 0.86 (0.77-0.94) in the validation dataset. CONCLUSIONS The algorithm demonstrated strong agreement with the participant-clinician consensus, enhancing confidence in CFHealthHub data. Publishingdata processing methods can encourage trust in digital endpoints and serve as an exemplar for other projects.
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Affiliation(s)
- Robert D Sandler
- Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Lana Lai
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Sophie Dawson
- Wolfson Adult Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Cameron
- Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aoife Lynam
- Cystic Fibrosis Unit, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Zhe Hui Hoo
- Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin J Wildman
- Adult CF Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
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Sinderholm Sposato N, Bjerså K, Gilljam M, Lannefors L, Fagevik Olsén M. Effectiveness of manual therapy interventions in cystic fibrosis care: a pilot study. J Bodyw Mov Ther 2024; 39:323-329. [PMID: 38876647 DOI: 10.1016/j.jbmt.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Cystic fibrosis (CF) is a severe genetic condition that affects multiple organ systems and imposes a substantial treatment burden. Regarding the lungs and airways, the progressive pathophysiological changes place a significant strain on the musculoskeletal components of the respiratory system for people with CF. This pilot study investigated the effectiveness of manual therapy interventions (MTIs) on thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain. METHOD A study with a pretest-posttest design was conducted with 15 eligible people with CF at the Sahlgrenska University Hospital CF Centre. After an initial set of diagnostic tests at baseline, the participants underwent eight weekly 30-min MTIs. The MTIs included passive joint mobilisation and soft tissue manipulation of primary and secondary anatomical areas of the musculoskeletal respiratory system. On the day of the final intervention, the baseline measurements were repeated. RESULTS Trends of increased thoracic mobility were observed following the intervention, with a statistically significant increase in respiratory muscle strength. No change in lung function was observed. Musculoskeletal pain before and after the intervention showed a significant decrease in tender points, and all participants reported positive experiences with MTIs. CONCLUSION MTIs may improve thoracic mobility, alleviate pain, and enhance respiratory muscle strength in people with CF. Further research is needed to confirm their potential role as a CF physiotherapy supplement. CLINICAL TRIAL ID NCT04696198.
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Affiliation(s)
- Niklas Sinderholm Sposato
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Primary Care, Närhälsan Majorna, Gothenburg, Sweden
| | - Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Lannefors
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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18
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Sims-Lucas S, Goetzman ES, Kleyman TR. Cystic fibrosis-related metabolic defects: crosstalk between ion channels and organs. J Clin Invest 2024; 134:e182329. [PMID: 38949023 PMCID: PMC11213462 DOI: 10.1172/jci182329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Cystic fibrosis is a debilitating disease characterized by a poor medical prognosis due to devastating lung injury. Recent medical advances targeting the major genetic mutation ΔF508 of the cystic fibrosis transmembrane conductance regulator (CFTR) protein have dramatically increased the lifespan of patients with this mutation. This development has led to major changes in the field and has pushed research beyond the ion transport nature of cystic fibrosis and toward multiorgan physiological reprogramming. In this issue of the JCI, Bae, Kim, and colleagues utilized a large animal pig model prior to the onset of disease. They revealed metabolic reprogramming and organ crosstalk that occurred prior to disease progression. These findings provide paradigm-shifting insight into this complex disease.
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Affiliation(s)
| | | | - Thomas R. Kleyman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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19
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Rabe H, Lönnermark E, Johansson E, Gilljam M, Jönsson B. In vitro stimulation with nontuberculous mycobacteria induced a stronger cytokine response in leukocytes isolated from individuals with latent tuberculosis compared to those isolated from active tuberculosis or cystic fibrosis patients. Tuberculosis (Edinb) 2024; 147:102504. [PMID: 38522174 DOI: 10.1016/j.tube.2024.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
Mycobacterium tuberculosis and opportunistic environmental non-tuberculous mycobacteria (NTM) can cause severe infection. Why latent tuberculosis infection advances to active disease, and why some individuals with cystic fibrosis (CF) develop pulmonary infections with NTM is still poorly understood. The aim of this study was to investigate the effector function of peripheral blood mononuclear cells (PBMC) from individuals with active or latent tuberculosis, individuals with CF with or without pulmonary NTM-infection and healthy controls, by measuring cytokine response to in vitro stimulation with different species of NTMs. The cytokine concentrations of IL-17A, IL-22, IL-23, IL-10, IL12p70 and IFN-γ were measured in PBMC-culture supernatants after stimulation with NTMs. PBMCs from individuals with latent tuberculosis infection showed strong IL-17A, IL-22, and IFN-γ responses compared to individuals with active tuberculosis or CF. IL-10 production was low in both tuberculosis groups compared to the CF groups and controls. This study suggests that IL-17A and IL-22 might be important to keep tuberculosis in a latent phase and that individuals with CF with an ongoing NTM infection seem to have a low cytokine response.
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Affiliation(s)
- Hardis Rabe
- Unit of Biological Function, Research Institutes of Sweden (RISE AB), Gothenburg, Sweden; Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Elisabeth Lönnermark
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden.
| | - Ewa Johansson
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
| | - Marita Gilljam
- Region Västra Götaland, Sahlgrenska University Hospital, Respiratory Medicine, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg CF Centre, Adult Clinic, Gothenburg, Sweden.
| | - Bodil Jönsson
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
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20
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Ciciriello F, Panariello F, Medino P, Biffi A, Alghisi F, Rosazza C, Annunziata P, Bouchè V, Grimaldi A, Guidone D, Venturini A, Alicandro G, Oggioni M, Cerino P, Paiola G, Gramegna A, Fiocchi A, Bandera A, Lucidi V, Cacchiarelli D, Galietta LJV, Colombo C. Covid-19 in cystic fibrosis patients compared to the general population: Severity and virus-host cell interactions. J Cyst Fibros 2024; 23:625-632. [PMID: 38508950 DOI: 10.1016/j.jcf.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/30/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND People with cystic fibrosis (pwCF) are considered at risk of developing severe forms of respiratory viral infections. We studied the consequences of COVID-19 and virus-host cell interactions in CF vs. non-CF individuals. METHODS We enrolled CF and non-CF individuals, with /without COVID-like symptoms, who underwent nasopharyngeal swab for detection of SARS-CoV-2. Gene expression was evaluated by RNA sequencing on the same nasopharyngeal swabs. Criteria for COVID-19 severity were hospitalization and requirement or increased need of oxygen therapy. RESULTS The study included 171 patients (65 pwCF and 106 non-CF individuals). Among them, 10 pwCF (15.4 %) and 43 people without CF (40.6 %) tested positive at RT-PCR. Symptomatic infections were observed in 8 pwCF (with 2 requiring hospitalization) and in 11 individuals without CF (6 requiring hospitalization). Host transcriptomic analysis revealed that genes involved in protein translation, particularly ribosomal components, were downregulated in CF samples irrespective of SARS-CoV-2 status. In SARS-CoV-2 negative individuals, we found a significant difference in genes involved with motile cilia expression and function, which were upregulated in CF samples. Pathway enrichment analysis indicated that interferon signaling in response to SARS-CoV-2 infection was upregulated in both pwCF and non-CF subjects. CONCLUSIONS COVID-19 does not seem to be more severe in CF, possibly due to factors intrinsic to this population: the lower expression of ribosomal genes may downregulate the protein translation machinery, thus creating an unfavorable environment for viral replication.
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Affiliation(s)
- Fabiana Ciciriello
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Panariello
- Telethon Institute of Genetics and Medicine (TIGEM), Armenise/Harvard Laboratory of Integrative Genomics, Pozzuoli, Italy
| | - Paola Medino
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilan, Italy
| | - Arianna Biffi
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilan, Italy
| | - Federico Alghisi
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Rosazza
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilan, Italy
| | - Patrizia Annunziata
- Telethon Institute of Genetics and Medicine (TIGEM), Armenise/Harvard Laboratory of Integrative Genomics, Pozzuoli, Italy; NEGEDIA (Next Generation Diagnostic srl), Pozzuoli, Italy
| | - Valentina Bouchè
- Telethon Institute of Genetics and Medicine (TIGEM), Armenise/Harvard Laboratory of Integrative Genomics, Pozzuoli, Italy
| | - Antonio Grimaldi
- Telethon Institute of Genetics and Medicine (TIGEM), Armenise/Harvard Laboratory of Integrative Genomics, Pozzuoli, Italy; Department of Translational Medicine, University of Naples Federico II, Naples, Italy
| | - Daniela Guidone
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Arianna Venturini
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Gianfranco Alicandro
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimo Oggioni
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Pellegrino Cerino
- Centro di Referenza Nazionale per l'analisi e studio di correlazione tra ambiente, animale e uomo. Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
| | - Giulia Paiola
- Cystic Fibrosis Center, Azienda Ospedaliero Universitaria Integrata di Verona, Pl. Aristide Stefani 1 37126 Verona, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Fiocchi
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Clinic of Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzina Lucidi
- Cystic Fibrosis Center, 'Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy
| | - Davide Cacchiarelli
- Telethon Institute of Genetics and Medicine (TIGEM), Armenise/Harvard Laboratory of Integrative Genomics, Pozzuoli, Italy; Department of Translational Medicine, University of Naples Federico II, Naples, Italy; School for Advanced Studies, Genomics and Experimental Medicine Program, University of Naples "Federico II", Naples, Italy
| | - Luis J V Galietta
- Department of Translational Medicine, University of Naples Federico II, Naples, Italy; Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy.
| | - Carla Colombo
- Pediatric Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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21
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Elidottir H, Bjarnadottir SR, Baldursson O, Jonsdottir B. Cystic fibrosis in Iceland and the high prevalence of the N1303K variant. Pediatr Pulmonol 2024; 59:1944-1951. [PMID: 38629430 DOI: 10.1002/ppul.27019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Cystic fibrosis (CF) is most common in populations of Northern European ancestry where the F508del variant predominates. In 2020, Iceland became a member of the European Cystic Fibrosis Society Patient Registry, and we launched an epidemiological study of CF in Iceland. The study aimed to determine the prevalence and the genetic variants present in the country. Furthermore, we aimed to describe the previous and the current situation regarding lung function, infections, complications, treatment, and follow-up to understand the strengths and weaknesses of CF care in Iceland. METHODS This retrospective study included all individuals in Iceland with a confirmed CF diagnosis between 1955 and 2021. We conducted a medical records search for CF diagnosis codes and found 30 people with CF who were included in the study. Two hundred sixteen clinical variables were registered. A descriptive analysis of these was performed. RESULTS The prevalence of CF in Iceland is 0.372:10,000 inhabitants. The F508del is the most common CF transmembrane conductance regulator (CFTR) variant (46.4%), closely followed by N1303K (44.6%). Staphylococcus aureus was the most common airway pathogen, followed by Pseudomonas aeruginosa. Nasal polyps and CF-related diabetes were the most common complications. Modern CF medications, including the recent CFTR modulators, are available. CONCLUSION Even though Iceland has a relatively low prevalence of CF, it holds the highest known prevalence of the N1303K variant in Europe. Access to necessary treatment is satisfactory, but improvements are advisable for some aspects of the routine assessments by best practice guidelines.
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Affiliation(s)
- Helga Elidottir
- Children's Hospital, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
- Department of Pediatrics, Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Respiratory Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, The University of Iceland, Reykjavik, Iceland
| | | | - Olafur Baldursson
- Department of Respiratory Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, The University of Iceland, Reykjavik, Iceland
| | - Brynja Jonsdottir
- Department of Respiratory Medicine, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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22
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Liu A, Chokshi M, Nguyen N, Powell RT, Stephan CC, Bao G. Cystic fibrosis cell models for high-throughput analysis and drug screening. J Cyst Fibros 2024; 23:716-724. [PMID: 39060183 DOI: 10.1016/j.jcf.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
Cystic fibrosis (CF) is a single-gene disorder that affects the lung, digestive system, and other organs. Mutations in the CF transmembrane conductance regulator (CFTR) gene are classified into several classes based on their pathogenic mechanism and clinical severity. The distinct and heterogeneous clinical behavior of each CF class and the respective CFTR mutations have made the development of a durable therapy for all CF patients extremely challenging. While the FDA-approved drug elexacaftor/tezacaftor/ivacaftor (Trikafta) benefits CF patients carrying at least one F508del mutation in CFTR, it's not effective for many CF patients carrying a variety of other CFTR mutations. To establish a better understanding of CF pathophysiology and aid the development of novel therapeutics for different classes of CF patients, we have created four CF-mutation-specific cell models that recapitulate respectively four distinct CF classes and disease phenotypes, as confirmed by sequencing, CFTR mRNA and protein quantification. The channel function of each cell model was first validated using a well-established FLIPR (Fluorescent Imaging Plate Reader) membrane potential assay and then assessed by the YFP-based functional assay. Integrated with a halide-sensitive fluorescent reporter, these CF cell models can be used for high-throughput drug screening, as demonstrated by a proof-of-concept study using Trikafta. These cell models have the potential to advance CFTR mutation-specific therapies thus addressing the unmet needs of CF patients with rare mutations.
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Affiliation(s)
- Aidi Liu
- Department of Bioengineering, Rice University, Houston, Texas 77030, USA
| | - Mithil Chokshi
- Department of Bioengineering, Rice University, Houston, Texas 77030, USA
| | - Nghi Nguyen
- Institute of Biosciences and Technology, Texas A&M University, Houston, Texas, 77030, USA
| | - Reid T Powell
- Institute of Biosciences and Technology, Texas A&M University, Houston, Texas, 77030, USA
| | - Clifford C Stephan
- Institute of Biosciences and Technology, Texas A&M University, Houston, Texas, 77030, USA
| | - Gang Bao
- Department of Bioengineering, Rice University, Houston, Texas 77030, USA.
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23
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Pontes L, Perini Leme Giordano AL, Reichert-Lima F, Gualtieri Beraquet CA, Leite Pigolli G, Arai T, Ribeiro JD, Gonçalves AC, Watanabe A, Goldman GH, Moretti ML, Zaninelli Schreiber A. Insights into Aspergillus fumigatus Colonization in Cystic Fibrosis and Cross-Transmission between Patients and Hospital Environments. J Fungi (Basel) 2024; 10:461. [PMID: 39057346 PMCID: PMC11277961 DOI: 10.3390/jof10070461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Approximately 60% of individuals with cystic fibrosis (CF) are affected by Aspergillus fumigatus infection. This condition is correlated with a decline in lung function and is identified as an independent risk factor contributing to hospital admissions among CF patients. This study investigates the dynamic interplay of A. fumigatus within the context of CF patients, tracing its evolution over time, with a specific emphasis on colonization dynamics. METHODS An analysis was conducted on 83 sequential A. fumigatus isolates derived from sputum samples of six patients receiving care at a renowned CF hospital in Brazil. Employing microsatellite genotyping techniques, alongside an investigation into cyp51A gene mutations, this research sheds light on the genetic variations, colonization, and resistance of A. fumigatus within the CF respiratory environment. RESULTS Our research findings indicate that CF patients can harbor A. fumigatus strains from the same clonal complexes for prolonged periods. Additionally, we identified that clinical isolates have the potential to spread among patients in the same healthcare facility, evidencing hospital contamination. Two patients who underwent long-term Itraconazole treatment did not show phenotypic resistance. However, one of these patients exhibited mutations in the cyp51A gene, indicating the need to monitor resistance to azoles in these patients colonized for long periods by A. fumigatus. We also observed co-colonization or co-infection involving multiple genotypes in all patients over time. CONCLUSION This comprehensive examination offers valuable insights into the pathogenesis of A. fumigatus infections in CF patients, potentially shaping future therapeutic strategies and management approaches. This enhanced understanding contributes to our knowledge of A. fumigatus impact on disease progression in individuals with cystic fibrosis. Additionally, the study provides evidence of cross-contamination among patients undergoing treatment at the same hospital.
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Affiliation(s)
- Laís Pontes
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Ana Luisa Perini Leme Giordano
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Franqueline Reichert-Lima
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Caio Augusto Gualtieri Beraquet
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Guilherme Leite Pigolli
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - José Dirceu Ribeiro
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Aline Cristina Gonçalves
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - Gustavo Henrique Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil;
| | - Maria Luiza Moretti
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Angélica Zaninelli Schreiber
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
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24
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Larcombe R, Coulthard K, Eaton V, Tai A, Reuter S, Ward M. Is there a multinational consensus of tobramycin prescribing and monitoring for cystic fibrosis? Survey of current therapeutic drug monitoring practices in USA/Canada, UK/Ireland, and Australia/New Zealand. Eur J Hosp Pharm 2024; 31:301-306. [PMID: 36600520 PMCID: PMC11265560 DOI: 10.1136/ejhpharm-2022-003545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Sophisticated scientific methods have facilitated dose individualisation with substantial advancements in therapeutic drug monitoring (TDM) practice. It is unclear whether these methods have translated to the clinical setting. This study aimed to determine current TDM practice for tobramycin monitoring in cystic fibrosis (CF) centres in the USA and Canada, UK and Ireland, and Australia and New Zealand due to a high prevalence of CF. METHODS A web-based survey was developed and circulated via CF specialist groups within the targeted geographical regions. Themes included centre demographics, tobramycin usage, dosing and infusion practices, TDM practices, and blood sampling methods. RESULTS In total 77 responses were received from 75 different CF centres over the 3-month evaluation period (October 2019-January 2020). Respondents were from the USA and Canada (60%), Australia and New Zealand (25%), and the UK and Ireland (15%). Tobramycin was used in 97% of sites, with an international variation in practice across all survey aspects including dosing and infusion practice. TDM-based dose adjustment in the UK and Ireland was most commonly based only on trough sample collection for avoidance of toxicity, where use of computer programs for targeting both efficacy and toxicity endpoints were most common in Australia and New Zealand. The underlying pharmacokinetic basis of that program was not known by 33% of sites who utilised a computer program for tobramycin dose individualisation. CONCLUSION There remains substantial heterogeneity in tobramycin management worldwide. Despite two decades of research into TDM of tobramycin, there has been a slow uptake of new technologies and evolution of practice. An improved understanding of TDM processes is required for translation of evidence-based research into clinical practice. International guidelines require updating due to the advances in research to support confidence in the changes in clinical practice.
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Affiliation(s)
- Rebecca Larcombe
- University of South Australia, Adelaide, South Australia, Australia
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | | | - Vaughn Eaton
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Andrew Tai
- Department Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Stephanie Reuter
- University of South Australia, Adelaide, South Australia, Australia
| | - Michael Ward
- University of South Australia, Adelaide, South Australia, Australia
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25
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Roca M, Masip E, Colombo C, Boon M, Hulst JM, Garriga M, de Koning BAE, Bulfamante A, de Boeck K, Ribes-Koninckx C, Calvo-Lerma J. Long-term evaluation of faecal calprotectin levels in a European cohort of children with cystic fibrosis. Arch Dis Child 2024; 109:552-556. [PMID: 38123920 DOI: 10.1136/archdischild-2023-326221] [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: 08/20/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Intestinal inflammation with contradictory data on faecal calprotectin (fCP) levels is documented in patients with cystic fibrosis (CF). The aim of this study was to longitudinally evaluate fCP in a cohort of children with CF and their relationship with clinical variables. DESIGN Prospective observational study to assess evolution of fCP levels, primary aimed at improving fat absorption. Along 1.5 years of follow-up (November 2016-May 2018) with four study visits pertaining to a pilot study (two of four) and to a clinical trial (two of four), the study outcomes were measured. SETTING Six European CF centres in the context of MyCyFAPP Project. SUBJECTS Children with CF and pancreatic insufficiency (2-18 years old). MAIN OUTCOME MEASUREMENTS fCP levels, pulmonary function (percentage of forced expiratory volume in 1 s (FEV1%)) and coefficient of fat absorption (CFA). Additionally, in the last two visits, gastrointestinal (GI) symptoms were evaluated through the PedsQL-GI Questionnaire. Linear mixed regression models were applied to assess association between fCP and FEV1, CFA and GI symptoms. RESULTS Twenty-nine children with CF and pancreatic insufficiency were included. fCP levels were inversely associated with total modified specific PedsQL-GI score (p=0.04) and positively associated with diarrhoea (p=0.03), but not with CFA. Along the four study visits, fCP significantly increased (from 62 to 256 µg/g) and pulmonary function decreased (from 97% to 87%), with a significant inverse association between the two study outcomes (p<0.001). CONCLUSIONS In children with CF, fCP levels are inversely associated with pulmonary function and thus the specificity of fCP as a marker of intestinal inflammation in paediatric patients with CF warrants further investigation.
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Affiliation(s)
- Maria Roca
- Health Research Institute La Fe, Valencia, Spain
| | - Etna Masip
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carla Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mieke Boon
- Department of Pediatrics, KU Leuven Hospital, Leuven, Belgium
| | - Jessie M Hulst
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Anna Bulfamante
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kris de Boeck
- Department of Pediatrics, KU Leuven Hospital, Leuven, Belgium
| | | | - Joaquim Calvo-Lerma
- Health Research Institute La Fe, Valencia, Spain
- Universitat de València, Valencia, Spain
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26
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Friedrich F, Petry LM, Garcia LDCE, Pieta MP, Meneses ADS, Bittencourt LB, Xavier LF, Antunes MOB, Grun LK, Lumertz M, Kunzelmann K, Pinto LA. Benzbromarone as adjuvant therapy for cystic fibrosis lung disease: a pilot clinical trial. J Bras Pneumol 2024; 50:e20230292. [PMID: 38896732 DOI: 10.36416/1806-3756/e20230292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/21/2023] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE Cystic fibrosis (CF) affects multiple organs, the most severe consequences being observed in the lungs. Despite significant progress in developing CF transmembrane conductance regulator-specific treatments for CF lung disease, exploring alternative CF-targeted medications seems reasonable. We sought to evaluate the potential beneficial effects of oral benzbromarone as an adjuvant therapy in CF patients with reduced lung function. METHODS This was a prospective open-label pilot study of oral benzbromarone (100 mg/day) administered once daily for 90 days. Patients were followed at a tertiary referral center in southern Brazil. Safety was assessed by the number of reported adverse events. Secondary objectives included percent predicted FEV1 (FEV1%) and pulmonary exacerbations. RESULTS Ten patients were enrolled. Benzbromarone was found to be safe, with no serious drug-related adverse events. Eight patients completed the study; the median relative change in FEV1% tended to increase during the treatment, showing an 8% increase from baseline at the final visit. However, a nonparametric test showed that the change was not significant (p = 0.06). Of a total of ten patients, only one experienced at least one pulmonary exacerbation during the study. CONCLUSIONS Oral benzbromarone appears to be safe, and improved FEV1% has been observed in patients with CF. Further assessment in larger trials is warranted to elucidate whether oral benzbromarone can be a potential adjuvant therapy for CF.
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Affiliation(s)
- Frederico Friedrich
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Lucas Montiel Petry
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Laura de Castro E Garcia
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Marina Puerari Pieta
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Amanda da Silva Meneses
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luana Braga Bittencourt
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luiza Fernandes Xavier
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Marcos Otávio Brum Antunes
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Lucas Kich Grun
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
- Laboratório de Imunobiologia, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Magali Lumertz
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Karl Kunzelmann
- Physiological Institute, University of Regensburg, Regensburg, Germany
| | - Leonardo Araujo Pinto
- Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
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27
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Crabbé A. Intracellular Pseudomonas aeruginosa: An Overlooked Reservoir in the Lungs of People with Cystic Fibrosis? Am J Respir Crit Care Med 2024; 209:1421-1423. [PMID: 38498854 PMCID: PMC11208970 DOI: 10.1164/rccm.202402-0388ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Aurélie Crabbé
- Laboratory of Pharmaceutical Microbiology Ghent University Ghent, Belgium
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28
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Esposito A, Rossi A, Stabile M, Pinto G, De Fino I, Melessike M, Tamanini A, Cabrini G, Lippi G, Aureli M, Loberto N, Renda M, Galietta LJV, Amoresano A, Dechecchi MC, De Gregorio E, Bragonzi A, Guaragna A. Assessing the Potential of N-Butyl-l-deoxynojirimycin (l-NBDNJ) in Models of Cystic Fibrosis as a Promising Antibacterial Agent. ACS Pharmacol Transl Sci 2024; 7:1807-1822. [PMID: 38898954 PMCID: PMC11184606 DOI: 10.1021/acsptsci.4c00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/21/2024]
Abstract
Over the past few years, l-iminosugars have revealed attractive pharmacological properties for managing rare diseases including Cystic Fibrosis (CF). The iminosugar N-butyl-l-deoxynojirimycin (l-NBDNJ, ent-1), prepared by a carbohydrate-based route, was herein evaluated for its anti-inflammatory and anti-infective potential in models of CF lung disease infection. A significant decrease in the bacterial load in the airways was observed in the murine model of Pseudomonas aeruginosa chronic infection in the presence of l-NBDNJ, also accompanied by a modest reduction of inflammatory cells. Mechanistic insights into the observed activity revealed that l-NBDNJ interferes with the expression of proteins regulating cytoskeleton assembly and organization of the host cell, downregulates the main virulence factors of P. aeruginosa involved in the host response, and affects pathogen adhesion to human cells. These findings along with the observation of the absence of an in vitro bacteriostatic/bactericidal action of l-NBDNJ suggest the potential use of this glycomimetic as an antivirulence agent in the management of CF lung disease.
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Affiliation(s)
- Anna Esposito
- Department
of Chemical, Materials and Production Engineering, University of Naples Federico II, Naples I-80125, Italy
| | - Alice Rossi
- Infections
and Cystic Fibrosis Unit, Division of Immunology, Transplantation
and Infectious Diseases, IRCCS San Raffaele
Scientific Institute, Milan I-20132, Italy
| | - Maria Stabile
- Department
of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples I-80131, Italy
| | - Gabriella Pinto
- Department
of Chemical Sciences, University of Naples
Federico II, Naples I-80126, Italy
| | - Ida De Fino
- Infections
and Cystic Fibrosis Unit, Division of Immunology, Transplantation
and Infectious Diseases, IRCCS San Raffaele
Scientific Institute, Milan I-20132, Italy
| | - Medede Melessike
- Infections
and Cystic Fibrosis Unit, Division of Immunology, Transplantation
and Infectious Diseases, IRCCS San Raffaele
Scientific Institute, Milan I-20132, Italy
| | - Anna Tamanini
- Section
of Clinical Biochemistry, Department of Engineering for Innovation
Medicine, University of Verona, Verona I-37134, Italy
| | - Giulio Cabrini
- Center on
Innovative Therapies for Cystic Fibrosis, Department of Life Sciences
and Biotechnology, University of Ferrara, Ferrara I-40121, Italy
| | - Giuseppe Lippi
- Section
of Clinical Biochemistry, Department of Engineering for Innovation
Medicine, University of Verona, Verona I-37134, Italy
| | - Massimo Aureli
- Department
of Medical Biotechnology and Translational Medicine, University of Milan, Milan I-20054, Italy
| | - Nicoletta Loberto
- Department
of Medical Biotechnology and Translational Medicine, University of Milan, Milan I-20054, Italy
| | - Mario Renda
- Telethon
Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples I-80078, Italy
| | - Luis J. V. Galietta
- Telethon
Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples I-80078, Italy
- Department
of Translational Medical Sciences (DISMET), University of Naples Federico II, Naples I-80131, Italy
| | - Angela Amoresano
- Department
of Chemical Sciences, University of Naples
Federico II, Naples I-80126, Italy
- Istituto
Nazionale Biostrutture e Biosistemi, Consorzio Interuniversitario, Rome I-00136, Italy
| | - Maria Cristina Dechecchi
- Section
of Clinical Biochemistry, Department of Engineering for Innovation
Medicine, University of Verona, Verona I-37134, Italy
| | - Eliana De Gregorio
- Department
of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples I-80131, Italy
| | - Alessandra Bragonzi
- Infections
and Cystic Fibrosis Unit, Division of Immunology, Transplantation
and Infectious Diseases, IRCCS San Raffaele
Scientific Institute, Milan I-20132, Italy
| | - Annalisa Guaragna
- Department
of Chemical Sciences, University of Naples
Federico II, Naples I-80126, Italy
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29
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Humaj-Grysztar M, Rachel M, Bonior J. Polish Cystic Fibrosis Patients' Health-Related Quality of Life and Its Influencing Factors: A Cross-Sectional, Single-Centre Study. Healthcare (Basel) 2024; 12:1183. [PMID: 38921297 PMCID: PMC11204049 DOI: 10.3390/healthcare12121183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
Cystic fibrosis (CF) is a disease characterized by long-term and troublesome symptoms that affect the patient's life. This study aimed to assess and compare the health-related quality of life (HRQoL) of Polish CF patients and identify factors influencing it. The study group consisted of 79 patients (6 to 42 years old), who filled in an age-appropriate Cystic Fibrosis Questionnaire-Revised. Medical data were collected from each patient's medical records. The domains with the highest HRQoL median were eating problems (88.89), digestive symptoms (77.78) and physical functioning (75.00). The lowest-rated domain was social functioning (61.90). Age negatively correlated with eight domains, and most strongly with treatment burden (rho = -0.474). Physical functioning positively correlated with all spirometry parameters, and most strongly with FEV1% (rho = 0.588). Treatment burden, body image and respiratory symptoms were positively correlated with all spirometry parameters except PEF%. Present exacerbations reduced scores in almost all domains, and in the MANCOVA model they were a significant factor differentiating patients' HRQoL. The univariate analysis of MANCOVA showed the significant effects of both health condition (F = 8.32, p = 0.005) and the COVID-19 pandemic (F = 5.89, p = 0.018) on social functioning domain, and of the place of residence on body image (F = 5.60, p = 0.21). A decreasing HRQoL with increasing age and during exacerbations indicates that it is important to focus on these aspects of patients' lives and ensure they received the necessary support from their healthcare providers.
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Affiliation(s)
- Magdalena Humaj-Grysztar
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Marta Rachel
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
- Allergology Outpatient Department, Provincial Hospital No 2, 35-301 Rzeszow, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland
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30
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Pessoa BP, Velloso M, Inácio ÉP, Otoni CDO, de Fuccio MB, Rezende BA, Rodrigues-Machado MG. Subclinical vascular, hemodynamic and arterial stiffness changes in adults with cystic fibrosis: cross-sectional observational study. Sci Rep 2024; 14:13178. [PMID: 38849403 PMCID: PMC11161579 DOI: 10.1038/s41598-024-63904-0] [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: 09/21/2023] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
Cardiovascular diseases can be an emerging complication in cystic fibrosis (CF), as the median life expectancy has improved considerably. The objective of this study was to compare vascular, hemodynamic parameters and arterial stiffness in adult CF patients with healthy participants pared by sex and age, and to assess the factors associated with arterial stiffness in the CF group. This is a cross-sectional observational study. The evaluation of cardiovascular parameters was performed non-invasively using Mobil-O-Graph. 36 individuals with CF and 35 controls were evaluated. The mean arterial pressure (96.71 ± 10.98 versus 88.61 ± 7.40 mmHg, p = 0.0005), cardiac output (4.86 ± 0.57 versus 4.48 ± 0.44 L/min, p = 0.002) and systolic volume (64.30 ± 11.91 versus 49.02 ± 9.31 ml, p < 0.0001) were significantly lower in the CF group. The heart rate was higher in the CF when compared to the control (77.18 ± 10.47 versus 93.56 ± 14.57 bpm, p < 0.0001). The augmentation index (AIx@75) was higher in the CF than control (29.94 ± 9.37 versus 16.52 ± 7.179%, p < 0.0001). In the multivariate model controlled by body mass index and Forced Expiratory Volume in the first second, central systolic blood pressure and reflection coefficient directly related to AIx@75. Negatively related to AIx@75 were age and systolic volume. The adjusted determination coefficient was 87.40%. Individuals with CF presented lower arterial blood pressures and changes in cardiac function with lower stroke volume and cardiac output. The AIx@75, an indirect index of arterial stiffness and direct index of left ventricular overload, is increased in this population. The subclinical findings suggest the need for earlier cardiovascular assessment in this population due to increased risks of cardiovascular disease.
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Affiliation(s)
- Bruno Porto Pessoa
- Post-Graduate Program in Health Sciences of Medical Sciences Faculty of Minas Gerais, Alameda Ezequiel Dias, 275-Centro, Belo Horizonte, MG, 30130-110, Brazil
- Adult Cystic Fibrosis Center, Júlia Kubitschek Hospital-FHEMIG, Rua Dr. Cristiano Rezende, 2745-Milionários, Belo Horizonte, MG, 30610-720, Brazil
- Rehabilitation Sciences Program, Federal University of Minas Gerais, Avenida Antônio Carlos 6627. Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Marcelo Velloso
- Rehabilitation Sciences Program, Federal University of Minas Gerais, Avenida Antônio Carlos 6627. Pampulha, Belo Horizonte, MG, 31270-901, Brazil
- Department of Physical Therapy, Federal University of Minas Gerais, Avenida Antônio Carlos 6627. Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Érika Pereira Inácio
- Adult Cystic Fibrosis Center, Júlia Kubitschek Hospital-FHEMIG, Rua Dr. Cristiano Rezende, 2745-Milionários, Belo Horizonte, MG, 30610-720, Brazil
| | - Claudineia de Oliveira Otoni
- Post-Graduate Program in Health Sciences of Medical Sciences Faculty of Minas Gerais, Alameda Ezequiel Dias, 275-Centro, Belo Horizonte, MG, 30130-110, Brazil
| | - Marcelo Bicallho de Fuccio
- Adult Cystic Fibrosis Center, Júlia Kubitschek Hospital-FHEMIG, Rua Dr. Cristiano Rezende, 2745-Milionários, Belo Horizonte, MG, 30610-720, Brazil
| | - Bruno Almeida Rezende
- Post-Graduate Program in Health Sciences of Medical Sciences Faculty of Minas Gerais, Alameda Ezequiel Dias, 275-Centro, Belo Horizonte, MG, 30130-110, Brazil
| | - Maria Glória Rodrigues-Machado
- Post-Graduate Program in Health Sciences of Medical Sciences Faculty of Minas Gerais, Alameda Ezequiel Dias, 275-Centro, Belo Horizonte, MG, 30130-110, Brazil.
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31
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Merigo F, Lagni A, Boschi F, Bernardi P, Conti A, Plebani R, Romano M, Sorio C, Lotti V, Sbarbati A. Loss of CFTR Reverses Senescence Hallmarks in SARS-CoV-2 Infected Bronchial Epithelial Cells. Int J Mol Sci 2024; 25:6185. [PMID: 38892373 PMCID: PMC11172982 DOI: 10.3390/ijms25116185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
SARS-CoV-2 infection has been recently shown to induce cellular senescence in vivo. A senescence-like phenotype has been reported in cystic fibrosis (CF) cellular models. Since the previously published data highlighted a low impact of SARS-CoV-2 on CFTR-defective cells, here we aimed to investigate the senescence hallmarks in SARS-CoV-2 infection in the context of a loss of CFTR expression/function. We infected WT and CFTR KO 16HBE14o-cells with SARS-CoV-2 and analyzed both the p21 and Ki67 expression using immunohistochemistry and viral and p21 gene expression using real-time PCR. Prior to SARS-CoV-2 infection, CFTR KO cells displayed a higher p21 and lower Ki67 expression than WT cells. We detected lipid accumulation in CFTR KO cells, identified as lipolysosomes and residual bodies at the subcellular/ultrastructure level. After SARS-CoV-2 infection, the situation reversed, with low p21 and high Ki67 expression, as well as reduced viral gene expression in CFTR KO cells. Thus, the activation of cellular senescence pathways in CFTR-defective cells was reversed by SARS-CoV-2 infection while they were activated in CFTR WT cells. These data uncover a different response of CF and non-CF bronchial epithelial cell models to SARS-CoV-2 infection and contribute to uncovering the molecular mechanisms behind the reduced clinical impact of COVID-19 in CF patients.
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Affiliation(s)
- Flavia Merigo
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (P.B.); (A.C.); (A.S.)
| | - Anna Lagni
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy;
| | - Federico Boschi
- Department of Engineering for Innovation Medicine, University of Verona, 37134 Verona, Italy;
| | - Paolo Bernardi
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (P.B.); (A.C.); (A.S.)
| | - Anita Conti
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (P.B.); (A.C.); (A.S.)
| | - Roberto Plebani
- Laboratory of Molecular Medicine, Center for Advanced Studies and Technology (CAST), Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (R.P.); (M.R.)
| | - Mario Romano
- Laboratory of Molecular Medicine, Center for Advanced Studies and Technology (CAST), Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (R.P.); (M.R.)
| | - Claudio Sorio
- General Pathology Section, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Virginia Lotti
- Microbiology Section, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy;
| | - Andrea Sbarbati
- Anatomy and Histology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (F.M.); (P.B.); (A.C.); (A.S.)
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32
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Turuvekere Vittala Murthy N, Vlasova K, Renner J, Jozic A, Sahay G. A new era of targeting cystic fibrosis with non-viral delivery of genomic medicines. Adv Drug Deliv Rev 2024; 209:115305. [PMID: 38626860 DOI: 10.1016/j.addr.2024.115305] [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: 01/06/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
Cystic fibrosis (CF) is a complex genetic respiratory disorder that necessitates innovative gene delivery strategies to address the mutations in the gene. This review delves into the promises and challenges of non-viral gene delivery for CF therapy and explores strategies to overcome these hurdles. Several emerging technologies and nucleic acid cargos for CF gene therapy are discussed. Novel formulation approaches including lipid and polymeric nanoparticles promise enhanced delivery through the CF mucus barrier, augmenting the potential of non-viral strategies. Additionally, safety considerations and regulatory perspectives play a crucial role in navigating the path toward clinical translation of gene therapy.
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Affiliation(s)
| | - Kseniia Vlasova
- Department of Pharmaceutical Sciences, College of Pharmacy at Oregon State University, Corvallis, OR 97331, USA
| | - Jonas Renner
- Department of Pharmaceutical Sciences, College of Pharmacy at Oregon State University, Corvallis, OR 97331, USA
| | - Antony Jozic
- Department of Pharmaceutical Sciences, College of Pharmacy at Oregon State University, Corvallis, OR 97331, USA
| | - Gaurav Sahay
- Department of Pharmaceutical Sciences, College of Pharmacy at Oregon State University, Corvallis, OR 97331, USA; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR 97201, USA; Department of Biomedical Engineering, Robertson Life Sciences Building, Oregon Health & Science University, Portland, OR 97201, USA.
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33
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Terlizzi V, Farrell PM. Update on advances in cystic fibrosis towards a cure and implications for primary care clinicians. Curr Probl Pediatr Adolesc Health Care 2024; 54:101637. [PMID: 38811287 DOI: 10.1016/j.cppeds.2024.101637] [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] [Indexed: 05/31/2024]
Abstract
During the past quarter century, the diagnosis and treatment of cystic fibrosis (CF) have been transformed by molecular sciences that initiated a new era with discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The knowledge gained from that breakthrough has had dramatic clinical impact. Although once a diagnostic dilemma with long delays, preventable deaths, and irreversible pathology, CF can now be routinely diagnosed shortly after birth through newborn screening programs. This strategy of pre-symptomatic identification has eliminated the common diagnostic "odyssey" that was a failure of the healthcare delivery system causing psychologically traumatic experiences for parents. Therapeutic advances of many kinds have culminated in CFTR modulator treatment that can reduce the effects of or even correct the molecular defect in the chloride channel -the basic cause of CF. This astonishing advance has transformed CF care as described fully herein. Despite this impressive progress, there are challenges and controversies in the delivery of care. Issues include how best to achieve high sensitivity newborn screening with acceptable specificity; what course of action is appropriate for children who are identified through the unavoidable incidental findings of screening tests (CFSPID/CRMS cases and heterozygote carriers); how best to ensure genetic counseling; when to initiate the very expensive but life-saving CFTR modulator drugs; how to identify new CFTR modulator drugs for patients with non-responsive CFTR variants; how to adjust other therapeutic modalities; and how to best partner with primary care clinicians. Progress always brings new challenges, and this has been evident worldwide for CF. Consequently, this article summarizes the major advances of recent years along with controversies and describes their implications with an international perspective.
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Affiliation(s)
- Vito Terlizzi
- Department of Pediatric Medicine, Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 24, Florence, Italy
| | - Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Clinical Sciences Center (K4/948), 600 Highland Avenue, Madison, WI 53792, USA.
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34
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Tony-Odigie A, Dalpke AH, Boutin S, Yi B. Airway commensal bacteria in cystic fibrosis inhibit the growth of P. aeruginosa via a released metabolite. Microbiol Res 2024; 283:127680. [PMID: 38520837 DOI: 10.1016/j.micres.2024.127680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
In cystic fibrosis (CF), Pseudomonas aeruginosa infection plays a critical role in disease progression. Although multiple studies suggest that airway commensals might be able to interfere with pathogenic bacteria, the role of the distinct commensals in the polymicrobial lung infections is largely unknown. In this study, we aimed to identify airway commensal bacteria that may inhibit the growth of P. aeruginosa. Through a screening study with more than 80 CF commensal strains across 21 species, more than 30 commensal strains from various species have been identified to be able to inhibit the growth of P. aeruginosa. The underlying mechanisms were investigated via genomic, metabolic and functional analysis, revealing that the inhibitory commensals may affect the growth of P. aeruginosa by releasing a large amount of acetic acid. The data provide information about the distinct roles of airway commensals and provide insights into novel strategies for controlling airway infections.
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Affiliation(s)
- Andrew Tony-Odigie
- Institute of Medical Microbiology and Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany
| | - Alexander H Dalpke
- Institute of Medical Microbiology and Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany
| | - Sébastien Boutin
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Heidelberg, Germany; University of Lübeck, Department of Infectious Diseases and Microbiology, Lübeck, Germany
| | - Buqing Yi
- Institute of Medical Microbiology and Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Tomlinson OW, Barker AR, Denford S, Williams CA. Adapting, restarting, and terminating a randomised control trial for people with cystic fibrosis: Reflections on the impact of the COVID-19 pandemic upon research in a clinical population. Contemp Clin Trials Commun 2024; 39:101294. [PMID: 38577655 PMCID: PMC10992694 DOI: 10.1016/j.conctc.2024.101294] [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: 10/17/2023] [Revised: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
Background Habitual physical activity (PA) and exercise form a cornerstone of the management of cystic fibrosis (CF), a genetically inherited pulmonary and digestive condition - whereby telehealth platforms have been proposed as a mechanism to engage remotely people with CF in PA and exercise. Methods To test this, in early 2020, the 'ActivOnline: Physical Activity in Cystic Fibrosis Trial' (ActiOn PACT) randomised control trial was established to examine whether an online intervention was effective at increasing PA in adolescents and adults with CF. Results The emergence of the COVID-19 pandemic in 2020 forced this trial to be paused and modified, with the adoption of online recruitment and remote assessment of outcome measures. Despite such adaptations in accord with frameworks developed by the National Institute for Health Research, this trial failed to recruit and was subsequently terminated. Conclusions This article details the authors reflections upon the proposed reasons for lack of recruitment, including improved technology and medications for people with CF, and contextualises this finding in relation to the wider issue of non-reporting of trial results in clinical research.
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Affiliation(s)
- Owen W. Tomlinson
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
- Department of Clinical and Biomedical Science, University of Exeter, Exeter, United Kingdom
| | - Alan R. Barker
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
| | - Sarah Denford
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Craig A. Williams
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
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Raut S, Singh K, Sanghvi S, Loyo-Celis V, Varghese L, Singh E, Gururaja Rao S, Singh H. Chloride ions in health and disease. Biosci Rep 2024; 44:BSR20240029. [PMID: 38573803 PMCID: PMC11065649 DOI: 10.1042/bsr20240029] [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: 01/09/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024] Open
Abstract
Chloride is a key anion involved in cellular physiology by regulating its homeostasis and rheostatic processes. Changes in cellular Cl- concentration result in differential regulation of cellular functions such as transcription and translation, post-translation modifications, cell cycle and proliferation, cell volume, and pH levels. In intracellular compartments, Cl- modulates the function of lysosomes, mitochondria, endosomes, phagosomes, the nucleus, and the endoplasmic reticulum. In extracellular fluid (ECF), Cl- is present in blood/plasma and interstitial fluid compartments. A reduction in Cl- levels in ECF can result in cell volume contraction. Cl- is the key physiological anion and is a principal compensatory ion for the movement of the major cations such as Na+, K+, and Ca2+. Over the past 25 years, we have increased our understanding of cellular signaling mediated by Cl-, which has helped in understanding the molecular and metabolic changes observed in pathologies with altered Cl- levels. Here, we review the concentration of Cl- in various organs and cellular compartments, ion channels responsible for its transportation, and recent information on its physiological roles.
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Affiliation(s)
- Satish K. Raut
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
| | - Kulwinder Singh
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
| | - Shridhar Sanghvi
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
- Department of Molecular Cellular and Developmental Biology, The Ohio State University, Columbus, OH, U.S.A
| | - Veronica Loyo-Celis
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
| | - Liyah Varghese
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
| | - Ekam R. Singh
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
| | | | - Harpreet Singh
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, U.S.A
- Department of Molecular Cellular and Developmental Biology, The Ohio State University, Columbus, OH, U.S.A
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Asensio-Grau A, Ferriz-Jordán M, Hervás D, Heredia A, García-Hernández J, Garriga M, Masip E, Carmen Collado M, Andrés A, Ribes-Koninckx C, Calvo-Lerma J. Faecal lipid profile as a new marker of fat maldigestion, malabsorption and microbiota. Pediatr Res 2024:10.1038/s41390-024-03209-0. [PMID: 38778229 DOI: 10.1038/s41390-024-03209-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Fat malabsorption in children with cystic fibrosis (CF) leads to poor nutritional status and altered colonic microbiota. This study aimed at establishing the faecal lipid profile in children with CF, and exploring associations between the faecal lipidome and microbiota. METHODS Cross-sectional observational study with children with CF and an age-matched control group. Faecal lipidome was analysed by UHLC-HRMS and microbiota profiling by 16S rRNA amplicon sequencing. RESULTS Among 234 identified lipid species, five lipidome clusters (LC) were obtained with significant differences in triacylglycerols (TG), diacylglycerols (DG), monoacylglycerols (MG) and fatty-acids (FA): LC1 subjects with good digestion and absorption: low TG and low MG and FA; LC2 good digestion and poor absorption: low TG and high MG and FA; LC3 Mild digestion and poor absorption: intermediate TG and high MG and FA; LC4 poor digestion and absorption: high TG and high MG and FA; LC5 outliers. Bacteroidota and Verrucomicrobiota decreased over LC1-LC4, while Proteobacteria increased. Nutritional status indicators were significantly higher in LC1 and decreased over LC2-LC4. CONCLUSION Assessing faecal lipidome may be relevant to determine how dietary lipids are digested and absorbed. This new evidence might be a method to support targeted nutritional interventions towards reverting fat maldigestion or malabsorption. IMPACT Lipidomic analysis enabled the identification of the lipid species related to maldigestion (triglycerides) or malabsorption (monoglycerides and fatty acids). Children with cystic fibrosis can be grouped depending on the faecal lipidome profile related to dietary fat maldigestion or malabsorption. The lipidome profile in faeces is related to the composition of microbiota and nutritional status indicators.
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Affiliation(s)
- Andrea Asensio-Grau
- Institute of Food Engineering (FoodUPV). Polytechnic University of València, 46022, València, Spain
- Joint Research Unit NutriCuraPDig, València, Spain
| | - Miguel Ferriz-Jordán
- Institute of Food Engineering (FoodUPV). Polytechnic University of València, 46022, València, Spain
| | - David Hervás
- Department of Statistics (EIO). Polytechnic University of València, 46022, València, Spain
| | - Ana Heredia
- Institute of Food Engineering (FoodUPV). Polytechnic University of València, 46022, València, Spain
- Joint Research Unit NutriCuraPDig, València, Spain
| | - Jorge García-Hernández
- Centre for Advanced Microbiology (CAMA). Polytechnic University of València, 46022, València, Spain
| | - María Garriga
- University Hospital Ramón y Cajal, 28034, Madrid, Spain
| | - Etna Masip
- Health Research Institute La Fe, 46026, València, Spain
| | - M Carmen Collado
- Institute of Agrochemistry and Food Technology. Spanish National Research Council (IATA-CSIC), 46980, València, Spain
| | - Ana Andrés
- Institute of Food Engineering (FoodUPV). Polytechnic University of València, 46022, València, Spain
- Joint Research Unit NutriCuraPDig, València, Spain
| | - Carmen Ribes-Koninckx
- Joint Research Unit NutriCuraPDig, València, Spain
- Health Research Institute La Fe, 46026, València, Spain
| | - Joaquim Calvo-Lerma
- Institute of Food Engineering (FoodUPV). Polytechnic University of València, 46022, València, Spain.
- Joint Research Unit NutriCuraPDig, València, Spain.
- Faculty of Pharmacy and Food Science. University of Valencia, Avda. Vicent Andrés Estellés s/n, Burjassot, 46100, València, Spain.
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Sun J, Hua L, He Y, Liu H, Liu Q, Chen M, Li J, Ye J, Fang D, Ji R, Chen Y, Yang C, Zhang J. Genetic analysis and functional study of novel CFTR variants in Chinese children with cystic fibrosis. Gene 2024; 907:148190. [PMID: 38246579 DOI: 10.1016/j.gene.2024.148190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To describe the clinical characteristics of Chinese cystic fibrosis (CF) patients and to investigate the variants of CFTR and their potential pathogenicity. STUDY DESIGN Chinese patients with potential CF diagnosis were studied. Clinical data were reviewed retrospectively from medical records. Whole exome sequencing and genetic evaluation were conducted to explore potential gene variants. The disruption of the variants to protein structure and function was explored and validated using in vitro experiments and in silico analysis. RESULTS Four patients were recruited to the study, three of them were diagnosed as CF, and one was diagnosed as CFTR-related disorder. The age at symptom onset for the patients in this study ranged from newborn to 6 years, while the age at diagnosis varied from 3 to 11 years. All four patients exhibited bilateral diffuse bronchiectasis with Pseudomonas aeruginosa infections, and three of them had malnutrition. Finger clubbing was observed in three patients, two of whom displayed mixed ventilatory dysfunction. The CFTR variants spectrum of Chinese children with CF differs from that of Caucasian. A total of six variants were identified, two of which were first reported (c.1219G > T [p.Glu407*] and c.1367delT [p.Ala457Leufs*12]). The nonsense variants c.1219G > T, c.1657C > T and c.2551C > T and the frameshift variant c.1367delT were predicted to introduce premature stop codon and produce shorten CFTR protein, which was also first validated by in vitro truncation assay in this study. The missense variant c.1810A > C was predicted to disrupt the function of the nucleotide-binding domain 1 (NBD1) in the CFTR protein. The splicing variant c.1766 + 5G > T caused skipping of exon 13 and damaged the integrity of CFTR protein. CONCLUSIONS Our study expands the spectrum of phenotypes and genotypes for CF of Chinese origin, which differs significantly from that of Caucasian. Genetic analysis and counseling are crucial and deserve extensive popularization for the diagnosis ofCF in patients of Chinese origin.
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Affiliation(s)
- Jingyi Sun
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Hua
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafang He
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haipei Liu
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quanhua Liu
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengxue Chen
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianmin Ye
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dingzhu Fang
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoxu Ji
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Yang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China; State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.
| | - Jianhua Zhang
- Department of Pediatric Pulmonology, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lam GY, Patel H, Sharpe H, Li D, Halloran K. Metabolic complications in lung transplantation for cystic fibrosis - A case control study. Heliyon 2024; 10:e30034. [PMID: 38707432 PMCID: PMC11066389 DOI: 10.1016/j.heliyon.2024.e30034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background Metabolic complications post-lung transplant are poorly understood and little is known about how these complications differ between patients with or without cystic fibrosis (pwCF and pwoCF). This study compared post-lung transplant outcomes between pwCF and pwoCF relating to survival and incidence of diabetes, dyslipidaemia, hypertension, and renal impairment. Methods A retrospective (2004-2017) case-control study involving 90 pwCF and 90 pwoCF (age, sex and year of transplant matched) was conducted. Demographic variables, pre/post-transplant metabolic diseases, blood investigations and medications were extracted. Descriptive statistics were used to describe the cohort. Mann-Whitney U and Chi-squared tests were used to analyse morbidity and mortality data. Regression analyses were used to identity independent variables that impacted clinical outcomes. Kaplan Meier analysis with log-rank testing was used to compare survival. Results PwCF were younger, had lower BMIs, and were less likely to have pre-transplant extracorporeal membrane oxygenation (ECMO) use. A total of 37 pwCF and 41 pwoCF died (p = 0.65) during the period of observation with no differences in survival. Adjusting for covariates of age, sex and BMI via multiple logistic regression, CF status was associated with a dramatic increased risk of new-onset diabetes post-transplant (adjusted odds ratio 28.7; 95 % CI, 28.76 to 108.7). No other differences in adjusted risk were found. Conclusions As pwCF had a greater adjusted risk of developing new post-transplant diabetes and experienced metabolic complications at similar rates as pwoCF, the findings highlight the need for rigorous monitoring of pwCF for possible metabolic complications post-transplant.
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Affiliation(s)
- Grace Y. Lam
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Hima Patel
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Heather Sharpe
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - David Li
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Kieran Halloran
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
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Shakkottai A, Kim S, Mitchell RB. Obstructive sleep apnea in children with cystic fibrosis on highly effective modulator therapy. Pediatr Pulmonol 2024. [PMID: 38742253 DOI: 10.1002/ppul.27061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is common in children with cystic fibrosis (CF). Highly effective modulator therapies (HEMT) have led to improved sinopulmonary disease, but whether this translates to a lower frequency of OSA is unknown. METHODS We conducted a single center retrospective review of polysomnographic (PSG) data from 2012 to 2023 in patients aged 0-18 years with CF to assess frequency of OSA. Participants were classified based on HEMT status. Logistic regression was used to quantify the association between HEMT and OSA with p < .05 considered significant. RESULTS Forty-nine children underwent PSG during the study period. Ten percent were of non-White race and 24% were of Hispanic ethnicity. Twenty-one children (43%) were on HEMT. These children were older than those not on modulators (11.6 vs. 6.4 years; p = .0001) but no different with respect to gender, race, nutritional status, or lung function. Twenty-eight (57%) children had OSA. Odds of having OSA were higher in the HEMT group (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 1.2-14.9; p = .02). Tonsillar hypertrophy was associated with an increased odds of having OSA independent of modulator status (OR: 6.6; 95% CI: 1.2-37.9; p = .03). CONCLUSIONS OSA is frequently diagnosed in the post-HEMT era in this large, racially diverse group of children with CF. Children on HEMT were older and more likely to have OSA as compared to those not on modulators but similar in nutritional status, lung function, and presence of upper airway pathology. Prospective studies are needed to further clarify the relationship between HEMT and OSA in children with CF.
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Affiliation(s)
- Aarti Shakkottai
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephany Kim
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron B Mitchell
- Department of Otolaryngology, Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Gourari-Bouzouina K, Boucherit-Otmani Z, Halla N, Seghir A, Baba Ahmed-Kazi Tani ZZ, Boucherit K. Exploring the dynamics of mixed-species biofilms involving Candida spp. and bacteria in cystic fibrosis. Arch Microbiol 2024; 206:255. [PMID: 38734793 DOI: 10.1007/s00203-024-03967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
Cystic fibrosis (CF) is an inherited disease that results from mutations in the gene responsible for the cystic fibrosis transmembrane conductance regulator (CFTR). The airways become clogged with thick, viscous mucus that traps microbes in respiratory tracts, facilitating colonization, inflammation and infection. CF is recognized as a biofilm-associated disease, it is commonly polymicrobial and can develop in biofilms. This review discusses Candida spp. and both Gram-positive and Gram-negative bacterial biofilms that affect the airways and cause pulmonary infections in the CF context, with a particular focus on mixed-species biofilms. In addition, the review explores the intricate interactions between fungal and bacterial species within these biofilms and elucidates the underlying molecular mechanisms that govern their dynamics. Moreover, the review addresses the multifaceted issue of antimicrobial resistance in the context of CF-associated biofilms. By synthesizing current knowledge and research findings, this review aims to provide insights into the pathogenesis of CF-related infections and identify potential therapeutic approaches to manage and combat these complex biofilm-mediated infections.
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Affiliation(s)
- Karima Gourari-Bouzouina
- Antibiotics Antifungal Laboratory, Physical Chemistry, Synthesis and Biological Activity (LapSab), Department of Biology, Faculty of Sciences, University of Tlemcen, BP 119, 13000, Tlemcen, Algeria.
| | - Zahia Boucherit-Otmani
- Antibiotics Antifungal Laboratory, Physical Chemistry, Synthesis and Biological Activity (LapSab), Department of Biology, Faculty of Sciences, University of Tlemcen, BP 119, 13000, Tlemcen, Algeria
| | - Noureddine Halla
- Laboratory of Biotoxicology, Pharmacognosy and Biological Recovery of Plants, Department of Biology, Faculty of Sciences, University of Moulay-Tahar, 20000, Saida, Algeria
| | - Abdelfettah Seghir
- Antibiotics Antifungal Laboratory, Physical Chemistry, Synthesis and Biological Activity (LapSab), Department of Biology, Faculty of Sciences, University of Tlemcen, BP 119, 13000, Tlemcen, Algeria
| | - Zahira Zakia Baba Ahmed-Kazi Tani
- Antibiotics Antifungal Laboratory, Physical Chemistry, Synthesis and Biological Activity (LapSab), Department of Biology, Faculty of Sciences, University of Tlemcen, BP 119, 13000, Tlemcen, Algeria
| | - Kebir Boucherit
- Antibiotics Antifungal Laboratory, Physical Chemistry, Synthesis and Biological Activity (LapSab), Department of Biology, Faculty of Sciences, University of Tlemcen, BP 119, 13000, Tlemcen, Algeria
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Alicandro G, Gramegna A, Bellino F, Sciarrabba SC, Lanfranchi C, Contarini M, Retucci M, Daccò V, Blasi F. Heterogeneity in response to Elexacaftor/Tezacaftor/Ivacaftor in people with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00057-2. [PMID: 38729849 DOI: 10.1016/j.jcf.2024.04.013] [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: 12/13/2023] [Revised: 02/27/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Highly effective modulators of the CFTR channel have been demonstrated to dramatically impact disease progression and outcome. However, real-world data indicates that the magnitude of the clinical benefit is not equal among all patients receiving the treatment. We aimed to assess the variability in treatment response (as defined by the 6-month change in sweat chloride concentration, forced expiratory volume in one second [ppFEV1], body mass index [BMI], and CF Questionnaire-Revised [CFQ-R] respiratory domain score) and identify potential predictors in a group of patients receiving Elexacaftor-Tezacaftor-Ivacaftor (ETI) triple combination therapy. METHODS This was a single-center, prospective cohort study enrolling adults with CF at a major center in Italy. We used linear regression models to identify a set of potential predictors (including CFTR genotype, sex, age, and baseline clinical characteristics) and estimate the variability in treatment response. RESULTS The study included 211 patients (median age: 29 years, range: 12-58). Median changes (10-90th percentile) from baseline were: - 56 mEq/L (-76; -27) for sweat chloride concentration, +14.5 points (2.5; 32.0) for ppFEV1, +0.33 standard deviation scores (-0.13; 1.05) for BMI and +17 points (0; 39) for the CFQ-R respiratory domain score. The selected predictors explained 23 % of the variability in sweat chloride concentration changes, 18 % of the variability in ppFEV1 changes, 39 % of the variability in BMI changes, and 65 % of the variability in CFQ-R changes. CONCLUSIONS This study highlights a high level of heterogeneity in treatment response to ETI, which can only be partially explained by the baseline characteristics of the disease.
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Affiliation(s)
- Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Paediatrics, Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Federica Bellino
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sathya Calogero Sciarrabba
- Department of Paediatrics, Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lanfranchi
- Department of Paediatrics, Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Contarini
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariangela Retucci
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Daccò
- Department of Paediatrics, Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Pessoa E, Ferreira M, Baixinho CL. Telerehabilitation in Children and Adolescents with Cystic Fibrosis: A Scoping Review. Healthcare (Basel) 2024; 12:971. [PMID: 38786383 PMCID: PMC11121520 DOI: 10.3390/healthcare12100971] [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: 04/05/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Cystic fibrosis requires regular monitoring and intervention by healthcare teams; despite that, adherence to therapeutic measures is less than desired. The evolution of technology has allowed much of the care provided in person to be replaced by a telehealth delivery model, but studies on telerehabilitation are scarce and dispersed. This scoping review aimed to identify which domains of rehabilitation intervention are mediated by information and communication technologies and how they are developed in the provision of care to children and adolescents with cystic fibrosis. The data collection was conducted in February and June 2023, following the three steps recommended by the JBI for this type of review: (1) the search was conducted in MEDLINE, CINAHL, Scopus, JBI, and Web of Science; (2) the bibliographic references obtained from the included articles were analysed; and (3) the grey literature was checked. The eligibility criteria were children and adolescents and rehabilitation interventions mediated by information and communication technologies. The five studies included in this review were subjected to analysis, and a narrative synthesis of the results was carried out. The interventions identified included physical exercise programs (60%), management of the therapeutic regimen (40%), and symptom control (40%). The information and communication technologies were web-based platforms, video games, and telephones. The use of telerehabilitation included face-to-face meetings to ensure participants performed the exercises correctly, monitor their response to exercise, and teach them how to avoid risky situations during home workouts. In all studies, exercise sessions were supervised by the participants' parents or caregivers.
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Affiliation(s)
- Ezequiel Pessoa
- Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
| | - Mara Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
- Centro Hospitalar Universitário Lisboa Norte, 1649-035 Lisbon, Portugal
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal;
- Center for Innovative Care and Health Technology (ciTechcare), 2410-541 Leiria, Portugal
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44
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Beach M, Nayanathara U, Gao Y, Zhang C, Xiong Y, Wang Y, Such GK. Polymeric Nanoparticles for Drug Delivery. Chem Rev 2024; 124:5505-5616. [PMID: 38626459 PMCID: PMC11086401 DOI: 10.1021/acs.chemrev.3c00705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
The recent emergence of nanomedicine has revolutionized the therapeutic landscape and necessitated the creation of more sophisticated drug delivery systems. Polymeric nanoparticles sit at the forefront of numerous promising drug delivery designs, due to their unmatched control over physiochemical properties such as size, shape, architecture, charge, and surface functionality. Furthermore, polymeric nanoparticles have the ability to navigate various biological barriers to precisely target specific sites within the body, encapsulate a diverse range of therapeutic cargo and efficiently release this cargo in response to internal and external stimuli. However, despite these remarkable advantages, the presence of polymeric nanoparticles in wider clinical application is minimal. This review will provide a comprehensive understanding of polymeric nanoparticles as drug delivery vehicles. The biological barriers affecting drug delivery will be outlined first, followed by a comprehensive description of the various nanoparticle designs and preparation methods, beginning with the polymers on which they are based. The review will meticulously explore the current performance of polymeric nanoparticles against a myriad of diseases including cancer, viral and bacterial infections, before finally evaluating the advantages and crucial challenges that will determine their wider clinical potential in the decades to come.
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Affiliation(s)
- Maximilian
A. Beach
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Umeka Nayanathara
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Yanting Gao
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Changhe Zhang
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Yijun Xiong
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Yufu Wang
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Georgina K. Such
- School
of Chemistry, The University of Melbourne, Parkville, Victoria 3010, Australia
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45
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Sloan CM, Sherrard LJ, Einarsson GG, Dupont LJ, Koningsbruggen-Rietschel SV, Simmonds NJ, Downey DG. Inhaled antimicrobial prescribing for Pseudomonas aeruginosa infections in Europe. J Cyst Fibros 2024; 23:499-505. [PMID: 38360460 DOI: 10.1016/j.jcf.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Prescribers have an increasing range of inhaled antimicrobial formulations to choose from when prescribing both eradication and chronic suppression regimens in cystic fibrosis (CF). This study aimed to investigate the decision-making process behind prescribing of inhaled antimicrobials for Pseudomonas aeruginosa infections. METHODS A questionnaire was developed using Microsoft Forms and then forwarded to 57 Principal Investigators (PIs), at each of the CF centres within the European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN). Data collection occurred between November 2021 and February 2022. RESULTS The response rate was 90 % (n = 51/57 PIs), with at least 50 % of CF centers in each of the 17 countries represented in the ECFS-CTN. Physicians used a median of eight factors in their decision-making process with delivery formulations (92.2 %), adherence history (84.3 %), and antibiotic side-effect profile (76.5 %) often selected. Nebulised tobramycin or colistin were frequently selected as the inhaled antimicrobial in first-line eradication (n = 45, 88.2 %) and chronic suppression regimens (n = 42, 82.4 %). Combination regimens were more often chosen in eradication (first-line: n = 35, 68.6 %, second-line: n = 34, 66.7 %) and later chronic suppression regimens (third-line: n = 27, 52.9 %) than monotherapy. For pwCF also prescribed CFTR modulator therapies, most PIs did not alter inhaled antimicrobial regimens (n = 40, 78.4 %), with few pwCF (n = 18, 35.3 %) or PIs (n = 10, 19.6 %) deciding to stop inhaled antimicrobials. CONCLUSIONS The inhaled antimicrobial prescribing decision-making process is multifactorial. Nebulised tobramycin or colistin are often used in initial eradication and chronic suppression regimens. To date, CFTR modulator therapy has had a limited impact on the prescribing of inhaled antimicrobial regimens.
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Affiliation(s)
- Callum M Sloan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - Gisli G Einarsson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | | | - Nicholas J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Damian G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health and Social Care Trust, Belfast, UK.
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Gramegna A, Addy C, Allen L, Bakkeheim E, Brown C, Daniels T, Davies G, Davies JC, De Marie K, Downey D, Felton I, Hafkemeyer S, Hamouda S, Kendall V, Lindberg U, Macek M, Mayell S, Pearlsman O, Schechter MS, Salvatori L, Sands D, Schwarz C, Shteinberg M, Taylor J, Taylor-Cousar JL, Taylor-Robinson D, Watkins B, Verkleij M, Bevan A, Castellani C, Drevinek P, Gartner S, Lammertyn E, Landau EEC, Middleton PG, Plant BJ, Smyth AR, van Koningsbruggen-Rietschel S, Burgel PR, Southern KW. Standards for the care of people with cystic fibrosis (CF); Planning for a longer life. J Cyst Fibros 2024; 23:375-387. [PMID: 38789317 DOI: 10.1016/j.jcf.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
This is the final of four papers updating standards for the care of people with CF. That this paper "Planning a longer life" was considered necessary, highlights how much CF care has progressed over the past decade. Several factors underpin this progress, notably increased numbers of people with CF with access to CFTR modulator therapy. As the landscape for CF changes, so do the hopes and aspirations of people with CF and their families. This paper reflects the need to consider people with CF not as a "problem" to be solved, but as a success, a potential and a voice to be heard. People with CF and the wider CF community have driven this approach, reflecting many of the topics in this paper. This exercise involved wide stakeholder engagement. People with CF are keen to contribute to research priorities and be involved in all stages of research. People with CF want healthcare professionals to respect them as individuals and consider the impact of our actions on the world around us. Navigating life presents challenges to all, but for people with CF these challenges are heightened and complex. In this paper we highlight the concerns and life moments that impact people with CF, and events that the CF team should aim to support, including the challenges around having a family. People with CF and their care teams must embrace the updated standards outlined in these four papers to enjoy the full potential for a healthier life.
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Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Respiratory Unit; Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Lorna Allen
- Cystic Fibrosis Trust (UK), 2nd Floor, One Aldgate, London, UK
| | - Egil Bakkeheim
- Norwegian Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
| | | | - Thomas Daniels
- NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHSFT, Southampton, UK
| | - Gwyneth Davies
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London, Imperial Biomedical Research Centre, Royal Brompton Hospital, London, UK
| | | | - Damian Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Imogen Felton
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, Guys and St Thomas' Hospital NHS Foundation Trust, London UK, National Heart & Lung Institute, Imperial College London, Imperial Biomedical Research Centre
| | - Sylvia Hafkemeyer
- Mukoviszidose Institut GmbH, subsidiary of the German Cystic Fibrosis association Mukoviszidose e. V., Bonn, Germany
| | - Samia Hamouda
- Bechir Hamza Children's Hospital of Tunis, Faculty of Medicine of Tunis, University Al Manar, Tunis, Tunisia
| | - Victoria Kendall
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ulrika Lindberg
- Skane University Hospital, Department of clinical sciences, Lund, Respiratory medicine and Allergology, Lund, Sweden
| | - Milan Macek
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine Charles University and Motol University Hospital, Prague, Czech Republic
| | - Sarah Mayell
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Michael S Schechter
- Division of Pulmonary and Sleep Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, USA
| | | | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Carsten Schwarz
- HMU-Health and Medical University, Division Cystic Fibrosis, CF Center, Clinic Westbrandenburg, Potsdam, Germany
| | - Michal Shteinberg
- Pulmonologuy institute and CF center, Carmel medical center and the Technion- Israel Institute of Technology, Haifa, Israel
| | - Julia Taylor
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jennifer L Taylor-Cousar
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, Denver, CO, USA, Division of Pulmonary Sciences and Critical Care Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Waterhouse Building Block F, University of Liverpool, Liverpool, L69 3GB, UK
| | - Bethan Watkins
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Marieke Verkleij
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, the Netherlands
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Silvia Gartner
- Cystic Fibrosis Unit and Pediatric Pulmonology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elise Lammertyn
- Cystic Fibrosis Europe, the Belgian CF Association, Brussels, Belgium
| | - Eddie Edwina C Landau
- The Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney and CITRICA, Dept Respiratory & Sleep Medicine, Westmead Hospital, Westmead, Australia
| | - Barry J Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, University College Cork, Cork, Ireland
| | - Alan R Smyth
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | | | - Pierre-Régis Burgel
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP) and Université Paris-Cité, Institut Cochin, Inserm U1016, Paris, France
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
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47
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Candeli N, Dayton T. Investigating pulmonary neuroendocrine cells in human respiratory diseases with airway models. Dis Model Mech 2024; 17:dmm050620. [PMID: 38813849 DOI: 10.1242/dmm.050620] [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] [Indexed: 05/31/2024] Open
Abstract
Despite accounting for only ∼0.5% of the lung epithelium, pulmonary neuroendocrine cells (PNECs) appear to play an outsized role in respiratory health and disease. Increased PNEC numbers have been reported in a variety of respiratory diseases, including chronic obstructive pulmonary disease and asthma. Moreover, PNECs are the primary cell of origin for lung neuroendocrine cancers, which account for 25% of aggressive lung cancers. Recent research has highlighted the crucial roles of PNECs in lung physiology, including in chemosensing, regeneration and immune regulation. Yet, little is known about the direct impact of PNECs on respiratory diseases. In this Review, we summarise the current associations of PNECs with lung pathologies, focusing on how new experimental disease models, such as organoids derived from human pluripotent stem cells or tissue stem cells, can help us to better understand the contribution of PNECs to respiratory diseases.
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Affiliation(s)
- Noah Candeli
- European Molecular Biology Laboratory (EMBL) Barcelona, Tissue Biology and Disease Modelling, 08003, Barcelona, Spain
| | - Talya Dayton
- European Molecular Biology Laboratory (EMBL) Barcelona, Tissue Biology and Disease Modelling, 08003, Barcelona, Spain
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48
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Xu Y, Liu Q, Wang B, Li Q, Chen Y, Yang Y, Zhu Z, Gong D, Zhang C, Wang G, Qian H. Tobramycin-mediated self-assembly of DNA nanostructures for targeted treatment of Pseudomonas aeruginosa-infected lung inflammation. Biomater Sci 2024; 12:2331-2340. [PMID: 38488889 DOI: 10.1039/d3bm02121a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Pseudomonas aeruginosa (PA) is one of the most common multidrug-resistant pathogens found in clinics, often manifesting as biofilms. However, due to the emergence of superbugs in hospitals and the overuse of antibiotics, the prevention and treatment of PA infections have become increasingly challenging. Utilizing DNA nanostructures for packaging and delivering antibiotics presents an intervention strategy with significant potential. Nevertheless, construction of functional DNA nanostructures with multiple functionalities and enhanced stability in physiological settings remains challenging. In this study, the authors propose a magnesium-free assembly method that utilizes tobramycin (Tob) as a mediator to assemble DNA nanostructures, allowing for the functionalization of DNA nanostructures by combining DNA and antibiotics. Additionally, our study incorporates maleimide-modified DNA into the nanostructures to act as a targeting moiety specifically directed towards the pili of PA. The targeting ability of the constructed functional DNA nanostructure significantly improves the local concentration of Tob, thereby reducing the side effects of antibiotics. Our results demonstrate the successful construction of a maleimide-decorated Tob/DNA nanotube (NTTob-Mal) for the treatment of PA-infected lung inflammation. The stability and biocompatibility of NTTob-Mal are confirmed, highlighting its potential for clinical applications. Furthermore, its specificity in recognizing and adhering to PA has been validated. In vitro experiments have shown its efficacy in inhibiting PA biofilm formation, and in a murine model, NTTob-Mal has exhibited significant therapeutic effectiveness against PA-induced pneumonia. In summary, the proposed antibiotic drug-mediated DNA nanostructure assembly approach holds promise as a novel strategy for targeted treatment of PA infections.
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Affiliation(s)
- Yuhang Xu
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Qian Liu
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
- Laboratory of Pharmacy and Chemistry, and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing, 400016, China
| | - Bin Wang
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
- Chongqing Key Laboratory of Precision Medicine and Prevention of Major Respiratory Diseases, Chongqing 400037, China
| | - Quan Li
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Yue Chen
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Yao Yang
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Zhihao Zhu
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Daohui Gong
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Chuan Zhang
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Key Laboratory for Molecular Engineering of Chiral Drugs, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Guansong Wang
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
- Chongqing Key Laboratory of Precision Medicine and Prevention of Major Respiratory Diseases, Chongqing 400037, China
| | - Hang Qian
- Institute of Respiratory Diseases, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
- Chongqing Key Laboratory of Precision Medicine and Prevention of Major Respiratory Diseases, Chongqing 400037, China
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49
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Drummond D, Roy C, Cornet M, Bucher J, Boussaud V, Pimpec-Barthes FL, Pontailler M, Raisky O, Lopez V, Barbanti C, Guillemain R, Renolleau S, Grimaud M, Oualha M, de Saint Blanquat L, Sermet-Gaudelus I. Acute respiratory failure due to pulmonary exacerbation in children with cystic fibrosis admitted in a pediatric intensive care unit: outcomes and factors associated with mortality. Respir Res 2024; 25:190. [PMID: 38685088 PMCID: PMC11059703 DOI: 10.1186/s12931-024-02778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Children with advanced pulmonary disease due to cystic fibrosis (CF) are at risk of acute respiratory failure due to pulmonary exacerbations leading to their admission to pediatric intensive care units (PICU). The objectives of this study were to determine short and medium-term outcomes of children with CF admitted to PICU for acute respiratory failure due to pulmonary exacerbation and to identify prognosis factors. METHODS This retrospective monocentric study included patients less than 18 years old admitted to the PICU of a French university hospital between 2000 and 2020. Cox proportional hazard regression methods were used to determine prognosis factors of mortality or lung transplant. RESULTS Prior to PICU admission, the 29 patients included (median age 13.5 years) had a severe lung disease (median Forced Expiratory Volume in 1 s percentage predicted at 29%). Mortality rates were respectively 17%, 31%, 34%, 41% at discharge and at 3, 12 and 36 months post-discharge. Survival rates free of lung transplant were 34%, 32%, 24% and 17% respectively. Risk factors associated with mortality or lung transplant using the univariate analysis were female sex and higher pCO2 and chloride levels at PICU admission, and following pre admission characteristics: home respiratory and nutritional support, registration on lung transplant list and Stenotrophomonas Maltophilia bronchial colonization. CONCLUSION Children with CF admitted to PICU for acute respiratory failure secondary to pulmonary exacerbations are at high risk of death, both in the short and medium terms. Lung transplant is their main chance of survival and should be considered early.
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Affiliation(s)
- David Drummond
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Charlotte Roy
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Matthieu Cornet
- Institut Necker Enfants Malades, INSERM U1151, CNRS, Université de Paris, Paris, France
- CBIO-Centre de BioInformatique. Ecole des Mines, Paris, France
| | - Julie Bucher
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Véronique Boussaud
- Hôpital Européen George Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Margaux Pontailler
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de chirurgie thoracique et cardio-vasculaire pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Olivier Raisky
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de chirurgie thoracique et cardio-vasculaire pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Vanessa Lopez
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service d'anesthésie et réanimation pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Claudio Barbanti
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service d'anesthésie et réanimation pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Romain Guillemain
- Hôpital Européen George Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sylvain Renolleau
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marion Grimaud
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Mehdi Oualha
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laure de Saint Blanquat
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Service de réanimation médico-chirurgicale pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Isabelle Sermet-Gaudelus
- Unité de Transplantation Pulmonaire Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
- Centre Maladies rares Mucoviscidose et maladies apparentées, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
- Institut Necker Enfants Malades, INSERM U1151, CNRS, Université de Paris, Paris, France.
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50
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Cai W, Li M, Xu Y, Li M, Wang J, Zuo Y, Cao J. The effect of respiratory muscle training on children and adolescents with cystic fibrosis: a systematic review and meta-analysis. BMC Pediatr 2024; 24:252. [PMID: 38622583 PMCID: PMC11017573 DOI: 10.1186/s12887-024-04726-x] [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: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Cystic fibrosis is a chronic genetic disease that can affect the function of the respiratory system. Previous reviews of the effects of respiratory muscle training in people with cystic fibrosis are uncertain and do not consider the effect of age on disease progression. This systematic review aims to determine the effectiveness of respiratory muscle training in the clinical outcomes of children and adolescents with cystic fibrosis. METHODS Up to July 2023, electronic databases and clinical trial registries were searched. Controlled clinical trials comparing respiratory muscle training with sham intervention or no intervention in children and adolescents with cystic fibrosis. The primary outcomes were respiratory muscle strength, respiratory muscle endurance, lung function, and cough. Secondary outcomes included exercise capacity, quality of life and adverse events. Two review authors independently extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2. The certainty of the evidence was assessed according to the GRADE approach. Meta-analyses where possible; otherwise, take a qualitative approach. RESULTS Six studies with a total of 151 participants met the inclusion criteria for this review. Two of the six included studies were published in abstract form only, limiting the available information. Four studies were parallel studies and two were cross-over designs. There were significant differences in the methods and quality of the methodology included in the studies. The pooled data showed no difference in respiratory muscle strength, lung function, and exercise capacity between the treatment and control groups. However, subgroup analyses suggest that inspiratory muscle training is beneficial in increasing maximal inspiratory pressure, and qualitative analyses suggest that respiratory muscle training may benefit respiratory muscle endurance without any adverse effects. CONCLUSIONS This systematic review and meta-analysis indicate that although the level of evidence indicating the benefits of respiratory muscle training is low, its clinical significance suggests that we further study the methodological quality to determine the effectiveness of training. TRIAL REGISTRATION The protocol for this review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023441829.
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Affiliation(s)
- WenQian Cai
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Li
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - JiaNan Wang
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - YaHui Zuo
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - JinJin Cao
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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