1
|
Diab Cáceres L, Zamarrón de Lucas E. [Cystic fibrosis: Epidemiology, clinical manifestations, diagnosis and treatment]. Med Clin (Barc) 2023; 161:389-396. [PMID: 37558605 DOI: 10.1016/j.medcli.2023.06.006] [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: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
Cystic fibrosis is a genetic and multisystemic disease. The main comorbidity in adulthood is respiratory involvement, with the presence of bronchiectasis, chronic bronchial infection and airflow obstruction. Until a decade ago, treatments were aimed at favoring secretion drainage, reducing respiratory exacerbations, controlling chronic bronchial infection and slowing functional deterioration, but with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, the cystic fibrosis paradigm has changed. This novel treatment goes a step further in the management of this disease, it is able to improve the production of defective CFTR protein and increase its expression on the cell surface, thus achieving a better functioning of ion exchange, fluidizing respiratory secretions and reducing airflow obstruction. In addition, there are currently different lines of research aimed at correcting the genetic defect that causes cystic fibrosis.
Collapse
Affiliation(s)
- Layla Diab Cáceres
- Unidad de Fibrosis Quística, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Ester Zamarrón de Lucas
- Unidad de Fibrosis Quística, Servicio de de Neumología, Hospital Universitario La Paz, Madrid
| |
Collapse
|
2
|
Munck A, Cheillan D, Audrezet MP, Guenet D, Huet F. [Newborn screening for cystic fibrosis in France]. Med Sci (Paris) 2021; 37:491-499. [PMID: 34003095 DOI: 10.1051/medsci/2021051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neonatal screening for cystic fibrosis has optimised the prognosis for patients allowing very early multidisciplinary care. Over the past 20 years, screening programmes have undergone major international expansion. The performances of the French neonatal cystic fibrosis screening programme, established in 2002, has met European guideline standards, with positive predictive value of 0.31 (against a minimum of 0.30) and sensitivity value of 0.95 (against a minimum of 0.95). It is also important to highlight the very high percentage of sweat tests performed (95.5%), of mutations identified (96.6%), the 9:1 ratio of cystic fibrosis cases to cases of inconclusive diagnosis achieved and the effectiveness of the strategy implemented for the detection of false negative cases. A new organisation for cystic fibrosis neonatal screening has now been established in France. It is vital that effectiveness is maintained throughout the process, from newborn maternity care to diagnosis in cystic fibrosis care centres, and that further knowledge is gained through exhaustive data collection and validation.
Collapse
Affiliation(s)
- Anne Munck
- Société française de dépistage néonatal, Paris, France - Centre de ressource et de compétence de la mucoviscidose, Hopital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - David Cheillan
- Société française de dépistage néonatal, Paris, France - Service biochimie et biologie moléculaire Grand Est, Centre de biologie et de pathologie Est, Groupement hospitalier Est-Hospices civils de Lyon, 59 boulevard Pinel, 69677 Bron Cedex, France - Commission de biologie - Centre national de coordination du dépistage néonatal, Paris, France
| | - Marie-Pierre Audrezet
- Commission de biologie - Centre national de coordination du dépistage néonatal, Paris, France - Service de génétique médicale et biologie de la reproduction, CHRU de Brest, Inserm UMR1078 - Génétique, génomique et biotechnologies, F-29200, Brest, France
| | - David Guenet
- Laboratoire de biologie médicale, Centre régional de dépistage néonatal, Service de biochimie, CHU de Caen Normandie, Caen, France
| | - Frédéric Huet
- Société française de dépistage néonatal, Paris, France - Service de pédiatrie 1 et génétique médicale, 14 rue Paul Gaffarel, BP 77908, 21079 Dijon Cedex, France
| |
Collapse
|
3
|
Exploring approaches to facilitate family communication of genetic risk information after cystic fibrosis population carrier screening. J Community Genet 2017; 9:71-80. [PMID: 28971321 DOI: 10.1007/s12687-017-0337-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023] Open
Abstract
Population carrier screening for cystic fibrosis (CF) enables individuals with no known family history of the condition to ascertain their risk of having a child with CF. When an individual is identified as a carrier of CF, a life-shortening condition, they are encouraged to inform their relatives who are at increased risk of being a carrier. Research suggests that the uptake of CF carrier testing amongst relatives of carriers or people with CF is low. This study aimed to explore approaches to facilitate the process of family communication of genetic information after an individual is identified as a carrier of CF through population screening. Five key informants were interviewed to inform the development of a telephone survey which was administered to 21 individuals identified as carriers of CF through population carrier screening at Victorian Clinical Genetics Services. This study suggests that providing carriers with additional information and follow-up support would be appreciated by carriers and could result in more accurate information being disseminated more widely within families, which could lead to more at-risk relatives accessing testing. Suggested strategies to enhance current practice include mailing a fact sheet to carriers and a follow-up telephone call provided by a genetic counsellor to carriers to offer further support in communicating this information to their relatives.
Collapse
|
4
|
Ioannou L, McClaren BJ, Massie J, Lewis S, Metcalfe SA, Forrest L, Delatycki MB. Population-based carrier screening for cystic fibrosis: a systematic review of 23 years of research. Genet Med 2014; 16:207-16. [PMID: 24030436 DOI: 10.1038/gim.2013.125] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022] Open
Abstract
Cystic fibrosis is the most common severe autosomal recessive disease, with a prevalence of 1 in 2,500-3,500 live births and a carrier frequency of 1 in 25 among Northern Europeans. Population-based carrier screening for cystic fibrosis has been possible since CFTR, the disease-causing gene, was identified in 1989. This review provides a systematic evaluation of the literature from the past 23 years on population-based carrier screening for cystic fibrosis, focusing on the following: uptake of testing; how to offer screening; attitudes, opinions, and knowledge; factors influencing decision making; and follow-up after screening. Recommendations are given for the implementation and evaluation of future carrier-screening programs.
Collapse
Affiliation(s)
- Liane Ioannou
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - John Massie
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia [3] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Laura Forrest
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Martin B Delatycki
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Medicine, Monash University, Clayton, Victoria, Australia [3] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [4] Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
5
|
Massie J, Gillam L. Uncertain diagnosis after newborn screening for cystic fibrosis: An ethics-based approach to a clinical dilemma. Pediatr Pulmonol 2014; 49:1-7. [PMID: 24166986 DOI: 10.1002/ppul.22933] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 08/18/2013] [Indexed: 11/05/2022]
Abstract
There is uncertainty about the diagnosis of cystic fibrosis after newborn screening (NBS) for some babies, either because of an intermediate sweat chloride test or inconclusive gene mutation analysis. There is considerable difficulty knowing how best to manage these babies, some of whom will develop cystic fibrosis, but many not. This article offers an ethics-based approach to this clinical dilemma that should be helpful to clinicians managing the baby with an uncertain diagnosis of cystic fibrosis after NBS.
Collapse
Affiliation(s)
- John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Children's Bioethics Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | | |
Collapse
|
6
|
McClaren BJ, Aitken M, Massie J, Amor D, Ukoumunne OC, Metcalfe SA. Cascade carrier testing after a child is diagnosed with cystic fibrosis through newborn screening: investigating why most relatives do not have testing. Genet Med 2013; 15:533-40. [DOI: 10.1038/gim.2012.175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022] Open
|
7
|
Abstract
PURPOSE OF REVIEW Newborn screening for cystic fibrosis (CF) is now universal in the US and many other countries. The rapid expansion of screening has resulted in numerous publications identifying new challenges for healthcare providers. This review provides an overview of these publications and includes ideas on managing these challenges. RECENT FINDINGS Most CF newborn screening algorithms involve DNA mutation analysis. As screening has expanded, new challenges have been identified related to carrier detection and inconclusive diagnoses. Early descriptions of infants with CF-related metabolic syndrome (CRMS) indicate that the natural history of this condition cannot be predicted. Early identification has also provided an opportunity to better understand the pathophysiology of CF. However, few studies have been conducted in infants with CF to determine optimal therapy and recommendations are largely anecdotal. SUMMARY Newborn screening provides an opportunity to identify and begin treatment early in individuals with CF. Whereas a single, optimal approach to screening does not exist, all programs can benefit from new findings regarding sweat testing, carrier detection, early pathophysiology, and clinical outcomes.
Collapse
|
8
|
Borte S, Wang N, Oskarsdóttir S, von Döbeln U, Hammarström L. Newborn screening for primary immunodeficiencies: beyond SCID and XLA. Ann N Y Acad Sci 2012; 1246:118-30. [PMID: 22236436 DOI: 10.1111/j.1749-6632.2011.06350.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary immunodeficiencies (PID) encompass more than 250 disease entities, including phagocytic disorders, complement deficiencies, T cell defects, and antibody deficiencies. While differing in clinical severity, early diagnosis and treatment is of considerable importance for all forms of PID to prevent organ damage and life-threatening infections. During the past few years, neonatal screening assays have been developed to detect diseases hallmarked by the absence of T or B lymphocytes, classically seen in severe combined immunodeficiencies (SCID) and X-linked agammaglobulinemia (XLA). As described in this review, a reduction or lack of T and B cells in newborns is also frequently found in several other forms of PID, requiring supplemental investigation and involving the development of additional technical platforms in order to help classify abnormal screening results.
Collapse
Affiliation(s)
- Stephan Borte
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | | | | | | |
Collapse
|
9
|
Massie RJH, Curnow L, Glazner J, Armstrong DS, Francis I. Lessons learned from 20 years of newborn screening for cystic fibrosis. Med J Aust 2012; 196:67-70. [DOI: 10.5694/mja11.10686] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R John H Massie
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Lisette Curnow
- Genetic Health Services Victoria, Murdoch Childrens Research Institute, Melbourne, VIC
| | - Judith Glazner
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC
| | - David S Armstrong
- Department of Respiratory Medicine, Monash Medical Centre, Melbourne, VIC
| | - Ivan Francis
- Newborn Screening, Victorian Clinical Genetics Services, Melbourne, VIC
| |
Collapse
|
10
|
Ross LF. A re-examination of the use of ethnicity in prenatal carrier testing. Am J Med Genet A 2011; 158A:19-23. [PMID: 22106058 DOI: 10.1002/ajmg.a.34361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/29/2011] [Indexed: 11/05/2022]
Abstract
In April 2011, the American Congress of Obstetricians and Gynecologists (formerly the American College of Obstetrics and Gynecology [ACOG]), updated its policy on carrier screening for cystic fibrosis and proposed that because of the increasing difficulty in assigning a single ethnicity to individuals, "It is reasonable, therefore to offer CF carrier screening to all patients." However, ACOG continues to use ethnicity in its guidelines about carrier testing for autosomal recessive disorders like sickle cell disease (SCD) and Tay-Sachs disease (TSD). This practice is in marked contrast with newborn screening (NBS) which is universally provided for all conditions. In this manuscript, I evaluate the discrepant role of ethnicity in NBS and carrier screening. I argue that ACOG needs to adopt the position it now takes for CF regarding prenatal carrier testing for all conditions. To promote equity in prenatal testing decision making, health care policies must acknowledge the diversity of the populations that we serve and empower all women and couples to make more fully informed reproductive decisions by offering prenatal carrier testing to all.
Collapse
|
11
|
|