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Abstract
BACKGROUND Osteoporosis is a disorder of bone mineralisation occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. This is an updated version of a previous review. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register of references (identified from electronic database searches and hand searches of journals and abstract books) on 5 May 2022. We performed additional searches of PubMed, clinicaltrials.gov and the WHO ICTRP (International Clinical Trials Registry Platform) on 5 May 2022. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Authors independently selected trials, extracted data and assessed risk of bias in included studies. Trial investigators were contacted to obtain missing data. We judged the certainty of the evidence using GRADE. MAIN RESULTS We included nine trials with a total of 385 participants (272 adults and 113 children (aged five to 18 years)). Trial durations ranged from six months to two years. Only two of the studies were considered to have a low risk of bias for all the domains. Bisphosphonates compared to control in people with cystic fibrosis who have not had a lung transplant Seven trials included only adult participants without lung transplants, one trial included both adults and children without lung transplantation (total of 238 adults and 113 children). We analysed adults (n = 238) and children (n = 113) separately. Adults Three trials assessed intravenous bisphosphonates (one assessed pamidronate and two assessed zoledronate) and five trials assessed oral bisphosphonates (one assessed risedronate and four assessed alendronate). Bisphosphonates were compared to either placebo or calcium (with or without additional vitamin D). Data showed no difference between treatment or control groups in new vertebral fractures at 12 months (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.09; 5 trials, 142 participants; very low-certainty evidence) and two trials (44 participants) reported no vertebral fractures at 24 months. There was no difference in non-vertebral fractures at 12 months (OR 2.11, 95% CI 0.18 to 25.35; 4 trials, 95 participants; very low-certainty evidence) and again two trials (44 participants) reported no non-vertebral fractures at 24 months. There was no difference in total fractures between groups at 12 months (OR 0.57, 95% CI 0.13 to 2.50; 5 trials, 142 participants) and no fractures were reported in two trials (44 participants) at 24 months. At 12 months, bisphosphonates may increase bone mineral density at the lumbar spine (mean difference (MD) 6.31, 95% CI 5.39 to 7.22; 6 trials, 171 participants; low-certainty evidence) and at the hip or femur (MD 4.41, 95% 3.44 to 5.37; 5 trials, 155 participants; low-certainty evidence). There was no clear difference in quality of life scores at 12 months (1 trial, 47 participants; low-certainty evidence), but bisphosphonates probably led to more adverse events (bone pain) at 12 months (OR 8.49, 95% CI 3.20 to 22.56; 7 trials, 206 participants; moderate-certainty evidence). Children The single trial in 113 children compared oral alendronate to placebo. We graded all evidence as low certainty. At 12 months we found no difference between treatment and placebo in new vertebral fractures (OR 0.32, 95% CI 0.03 to 3.13; 1 trial, 113 participants) and non-vertebral fractures (OR 0.19, 95% CI 0.01 to 4.04; 1 trial, 113 participants). There was also no difference in total fractures (OR 0.18, 95% CI 0.02 to 1.61; 1 trial, 113 participants). Bisphosphonates may increase bone mineral density at the lumbar spine at 12 months (MD 14.50, 95% CI 12.91 to 16.09). There was no difference in bone or muscle pain (MD 3.00, 95% CI 0.12 to 75.22), fever (MD 3.00, 95% CI 0.12 to 75.22) or gastrointestinal adverse events (OR 0.67, 95% CI 0.20 to 2.26). The trial did not measure bone mineral density at the hip/femur or report on quality of life. Bisphosphonates compared to control in people with cystic fibrosis who have had a lung transplant One trial of 34 adults who had undergone lung transplantation compared intravenous pamidronate to no bisphosphonate treatment. It did not report at 12 months and we report the 24-month data (not assessed by GRADE). There was no difference in the number of fractures, either vertebral or non-vertebral. However, bone mineral density increased with treatment at the lumbar spine (MD 6.20, 95% CI 4.28 to 8.12) and femur (MD 7.90, 95% CI 5.78 to 10.02). No participants in either group reported either bone pain or fever. The trial did not measure quality of life. AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates may increase bone mineral density in people with cystic fibrosis, but there are insufficient data to determine whether treatment reduces fractures. Severe bone pain and flu-like symptoms may occur with intravenous bisphosphonates. Before any firm conclusions can be drawn, trials in larger populations, including children, and of longer duration are needed to determine effects on fracture rate and survival. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids can ameliorate or prevent these adverse events. Future trials should also assess gastrointestinal adverse effects associated with oral bisphosphonates.
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Affiliation(s)
- Tomas C Jeffery
- Emergency Department, Queensland Health, Brisbane, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise S Conwell
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Australia
- Children's Health Queensland Clinical Unit, Greater Brisbane Clinical School, Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Mora Vallellano J, Delgado Pecellín C, Delgado Pecellín I, Quintana Gallego E, López-Campos JL. Evaluation of bone metabolism in children with cystic fibrosis. Bone 2021; 147:115929. [PMID: 33737192 DOI: 10.1016/j.bone.2021.115929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) bone disease (CFBD) has attracted considerable recent interest from researchers, although several aspects of CFBD pathophysiology remain poorly understood. The objective of this research was to investigate CFBD in children with CF and its relation to clinical and bone metabolism markers. METHODS In a prospective observational study of 68 patients with CF and 63 healthy controls, we studied bone turnover biomarkers and bone mineral density (BMD). The biomarkers included osteocalcin, total-alkaline phosphatase, bone-alkaline phosphatase, N-terminal propeptide of type-1-procollagen, osteoprotegerin (OPG), interleukine-6, tumor necrosis factor alpha (TNF-α), type-1-collagen cross-linked C-telopeptide (CTX), parathormone (PTH), 25-vitamin D, 1,25-vitamin D, calcium and phosphorus. BMD was examined in lumbar spine, comparing two healthy Spanish populations. Two regression analyses were applied to any significant associations to evaluate predictors of BMD and of CF, expressed as odds ratios (OR) with 95% confidence intervals. RESULTS After adjusting for age, sex, and height Z-score, gains in BMD LS in children and adolescents (6-16 years) with CF were not less than in healthy reference population. Patients with CF showed significant associations with different bone turnover biomarkers. Age, gender, body mass index, PTH, CTX and OPG were significant predictors of BMD (R2 = 0.866, p < 0,001). Moreover, we found that PTH (OR = 1.070; 95% CI 1.019-1.123), and TNFα (OR = 2.173; 95% CI 1.514-3.118) were significantly linked to CF, and calcium (OR = 0.115; 95% CI 0.025-0.524), 1,25-vitamin D (OR = 0.979; 95% CI 0.962 0.996) and OPG (OR = 0.189; 95% CI 0.073-0.489) were significant reduced. CONCLUSION A normal bone mineral density along with altered remodeling was found in CF patients with a normal nutritional status and without acute lung disease.
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Affiliation(s)
| | | | - Isabel Delgado Pecellín
- Hospital Universitario Virgen del Rocío, Unidad de Fibrosis Quística, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Quintana Gallego
- Hospital Universitario Virgen del Rocío, Unidad de Fibrosis Quística, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Virgen del Rocío, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS)/Universidad de Sevilla, Sevilla, Spain
| | - José Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Virgen del Rocío, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS)/Universidad de Sevilla, Sevilla, Spain
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Rayas MS, Kelly A, Hughan KS, Daley T, Zangen D. Adrenal function in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S74-S81. [PMID: 31679732 DOI: 10.1016/j.jcf.2019.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022]
Abstract
Cystic fibrosis (CF) is not known to directly affect the adrenal gland, but commonly used CF therapies do impact the function of the hypothalamic-pituitary-adrenal (HPA) axis. By binding to the glucocorticoid receptor, medications such as inhaled and oral corticosteroids can enhance the systemic effects of cortisol and result in iatrogenic Cushing syndrome. Prolonged use suppresses the body's ability to make cortisol, resulting in iatrogenic adrenal insufficiency upon medication discontinuation. Chronic use of inhaled and oral corticosteroids can negatively affect bone health, growth, and glucose metabolism. This chapter provides practical guidelines regarding the screening, diagnosis, and treatment of iatrogenic adrenal insufficiency. As the guidelines are mainly derived from the asthma literature, this chapter also highlights the need for studies to evaluate the impact of CF therapies on adrenal function and other CF-endocrinopathies.
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Affiliation(s)
- Maria Socorro Rayas
- Division of Pediatric Endocrinology and Diabetes, University of Texas Health San Antonio, 7703 Floyd Curl, San Antonio, TX 78229, USA.
| | - Andrea Kelly
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine of University of Pennsylvania, 2716 South Street, Philadelphia, PA 19146, USA.
| | - Kara S Hughan
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | - Tanicia Daley
- Division of Pediatric Endocrinology and Metabolism, Emory Children's Center/Emory Pediatric Institute, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA 30329, USA.
| | - David Zangen
- Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem 91240, Israel.
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Ubago-Guisado E, Cavero-Redondo I, Alvarez-Bueno C, Vlachopoulos D, Martínez-Vizcaíno V, Gracia-Marco L. Bone Health in Children and Youth with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Matched Cohort Studies. J Pediatr 2019; 215:178-186.e16. [PMID: 31519442 DOI: 10.1016/j.jpeds.2019.07.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the evidence regarding the differences in areal bone mineral density (aBMD) between children and adolescents with cystic fibrosis (CF) compared with their healthy peers, based on data from longitudinal studies. STUDY DESIGN We searched MEDLINE, SPORTDiscus, the Cochrane Library, PEDro (Physiotherapy Evidence Database), and Embase databases. Observational studies addressing the change of aBMD in children with CF and healthy children and adolescents were eligible. The DerSimonian and Laird method was used to compute pooled estimates of effect sizes (ES) and 95% CIs for the change of whole body (WB), lumbar spine (LS), and femoral neck (FN) aBMD. RESULTS Six studies with participants with CF and 26 studies with healthy participants were included in the systematic review and meta-analysis. For the analysis in children with CF, the pooled ES for the change of WB aBMD was 0.29 (95% CI -0.15 to 0.74), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.09 (95% CI -0.39 to 0.57). For the analysis in healthy children, the pooled ES for the change of WB aBMD was 0.37 (95% CI 0.26-0.49), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.52 (95% CI 0.19-0.85). CONCLUSIONS aBMD development might not differ between children and adolescents with CF receiving medical care compared with their healthy peers. Further longitudinal studies in a CF population during growth and development are required to confirm our findings.
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Affiliation(s)
- Esther Ubago-Guisado
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Nursing Faculty, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | - Celia Alvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Nursing Faculty, Universidad de Castilla-La Mancha, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Región Metropolitana, Chile
| | - Luis Gracia-Marco
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain; Growth, Exercise, Nutrition and Development Research Group, Universidad de Zaragoza, Zaragoza, Spain
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Daley T, Hughan K, Rayas M, Kelly A, Tangpricha V. Vitamin D deficiency and its treatment in cystic fibrosis. J Cyst Fibros 2019; 18 Suppl 2:S66-S73. [DOI: 10.1016/j.jcf.2019.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/16/2022]
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Sharma S, Jaksic M, Fenwick S, Byrnes C, Cundy T. Accrual of Bone Mass in Children and Adolescents With Cystic Fibrosis. J Clin Endocrinol Metab 2017; 102:1734-1739. [PMID: 28323913 DOI: 10.1210/jc.2016-3459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Low bone density is a complication of cystic fibrosis (CF). HYPOTHESIS Accrual of bone mass is most impaired in the sickest children, as judged by nutritional status and pulmonary function. DESIGN Retrospective analysis of correlation between lumbar spine bone mineral density (BMD), body mass index (BMI), and forced expiratory volume in 1 second (FEV1) z scores in children and adolescents with CF. SETTING Pediatric hospital specialist CF service. PATIENTS Sixty participants aged 5.9 to 18.8 years (24 female) with confirmed CF. INTERVENTIONS Lumbar spine BMD, BMI, and FEV1 z scores measured at first BMD scan; 40 participants had sequential scans. Change in L1-L4 z scores over time was used as a measure of bone accrual, and BMI as a measure of nutritional status. OUTCOME MEASURES Correlations between lumbar spine BMD, BMI, and FEV1 z scores. RESULTS Mean BMI and BMD z scores were strongly correlated at the initial scan (P < 0.0001), suggesting that nutritional status is a major determinant of BMD. In the sequential scan at a mean age of 16.1 years, height centile was maintained, indicating normal linear growth. Changes in BMI and BMD z scores were positively correlated (P = 0.001), indicating that patients failing to gain weight appropriately with growth were also failing to acquire bone normally. Change in FEV1 z score was correlated with change in both BMD (P < 0.0001) and BMI z scores (P = 0.02). CONCLUSION Although young people with CF may be maintaining normal growth in height, bone accrual is impaired in those with the poorest nutritional status and lung function.
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Affiliation(s)
- Sonakshi Sharma
- Department of Endocrinology, Greenlane Clinical Centre, Auckland 1051, New Zealand
| | - Mirjana Jaksic
- Department of Paediatrics, Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Respiratory Service, Starship Children's Hospital, Auckland 1023, New Zealand
| | - Sheryl Fenwick
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Catherine Byrnes
- Department of Paediatrics, Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Respiratory Service, Starship Children's Hospital, Auckland 1023, New Zealand
| | - Tim Cundy
- Department of Endocrinology, Greenlane Clinical Centre, Auckland 1051, New Zealand
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
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Hubert G, Chung TT, Prosser C, Lien D, Weinkauf J, Brown N, Goodvin M, Jackson K, Tabak J, Salgado J, Alzaben AS, Mager DR. Bone Mineral Density and Fat-Soluble Vitamin Status in Adults with Cystic Fibrosis Undergoing Lung Transplantation: A Pilot Study. CAN J DIET PRACT RES 2016; 77:199-202. [DOI: 10.3148/cjdpr-2016-014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Patients with cystic fibrosis (CF) often experience low bone mineral density (BMD) pre- and post-lung transplantation (LTX). The study purpose was to describe BMD and micronutrient status in adults with CF pre- and post-LTX. Methods: Twelve patients with CF (29 ± 8 years) were recruited from the CF clinic at the University of Alberta Lung Transplant Program. BMD and vitamins A, D, E, K status, and parathyroid hormone were measured pre- and post-LTX. Results: No significant differences pre- and post-LTX were observed at the different bone sites measured (lumber–spine, femoral–neck (FN), hip, and femoral–trochlea) (P > 0.05). BMD T-scores (<−2) was present in lumbar–spine, FN, hip, and femoral–trochlea in 33%, 17%, 17%, and 25% of individuals pre-LTX and 58%, 33%, 58%, and 33% of individuals post-LTX, respectively. More than 50% of patients had suboptimal vitamin K levels (PIVKA-II values >3 ng/mL) pre- and post-LTX. Conclusion: Adults with CF pre- and post-LTX had reduced BMD and suboptimal vitamin K status.
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Affiliation(s)
- Grace Hubert
- Nutrition Services, Alberta Health Services, Edmonton, AB
| | | | - Connie Prosser
- Department of Laboratory Medicine, University of Alberta, Edmonton, AB
| | - Dale Lien
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Justin Weinkauf
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Neil Brown
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | | | - Kathy Jackson
- Lung Transplant Program, Alberta Health Services, Edmonton, AB
| | - Joan Tabak
- Adult Cystic Fibrosis Clinic, Alberta Health Services, Edmonton, AB
| | - Josette Salgado
- Adult Cystic Fibrosis Clinic, Alberta Health Services, Edmonton, AB
| | - Abeer Salman Alzaben
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB
| | - Diana R. Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB
- Department of Pediatrics, University of Alberta, Edmonton, AB
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Liu Z, Guo J, Wang Y, Weng Z, Huang B, Yu MK, Zhang X, Yuan P, Zhao H, Chan WY, Jiang X, Chan HC. CFTR-β-catenin interaction regulates mouse embryonic stem cell differentiation and embryonic development. Cell Death Differ 2016; 24:98-110. [PMID: 27834953 DOI: 10.1038/cdd.2016.118] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/04/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022] Open
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-regulated anion channel capable of conducting both Cl- and HCO3-, mutations of which cause cystic fibrosis (CF), a common autosomal recessive disease. Although CF patients are known to have varied degree of developmental problems, the biological role of CFTR in embryonic development remains elusive. Here, we show that CFTR is functionally expressed in mouse ESCs. CFTR-/- mESCs exhibit dramatic defect in mesendoderm differentiation. In addition, CFTR physically interacts with β-catenin, defect of which leads to premature degradation of β-catenin and suppressed activation of β-catenin signaling. Furthermore, knockdown of CFTR retards the early development of Xenopus laevis with impaired mesoderm/endoderm differentiation and β-catenin signaling. Our study reveals a previously undefined role of CFTR in controlling ESC differentiation and early embryonic development via its interaction with β-catenin, and provides novel insights into the understanding of embryonic development.
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Affiliation(s)
- Zhenqing Liu
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Jinghui Guo
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Yan Wang
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Zhihui Weng
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Biao Huang
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Mei-Kuen Yu
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Xiaohu Zhang
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,Sichuan University-The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Chengdu, PR China
| | - Ping Yuan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Hui Zhao
- Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China
| | - Wai-Yee Chan
- Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China
| | - Xiaohua Jiang
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China
| | - Hsiao-Chang Chan
- Epithelial Cell Biology Research Center, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,Sichuan University-The Chinese University of Hong Kong Joint Laboratory for Reproductive Medicine, West China Second University Hospital, Chengdu, PR China.,Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, PR China.,School of Biomedical Sciences Core Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, PR China
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Braun C, Bacchetta J, Reix P. [Insights into cystic fibrosis-related bone disease]. Arch Pediatr 2016; 23:857-66. [PMID: 27345551 DOI: 10.1016/j.arcped.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/17/2016] [Accepted: 05/11/2016] [Indexed: 02/04/2023]
Abstract
With the increasing life expectancy of patients with cystic fibrosis (CF), prevalence of late complications such as CF-related bone disease (CFBD) has increased. It was initially described in 24% of the adult population with CF and has also been reported in the pediatric population. CFBD is multifactorial and progresses in different steps. Both decreased bone formation and increased bone resorption (in different amounts) are observed. CFBD is likely primitive (directly related to the CFTR defect itself), but is also worsened by acquired secondary factors such as lung infections, chronic inflammation, denutrition, vitamin deficiency, and decreased physical activity. CFBD may be clinically apparent (i.e., mainly vertebral and costal fractures), or clinically asymptomatic (therefore corresponding to abnormalities in bone density and architecture). CFBD management mainly aims to prevent the occurrence of fractures. Prevention and regular monitoring of bone disease as early as 8 years of age is of the utmost importance, as is the control of possible secondary deleterious CFBD factors. New radiological tools, such as high-resolution peripheral quantitative computed tomography, allow an accurate evaluation of cortical and trabecular bone micro-architecture in addition to compartmental density; as such, they will likely improve the assessment of the bone fracture threat in CF patients in the near future.
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Affiliation(s)
- C Braun
- Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France
| | - J Bacchetta
- Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France; Centre de référence des maladies rénales rares, hôpital femme mère enfant, 69500 Bron, France; Inserm 1033 LYOS, prévention des maladies osseuses, 69008 Lyon, France
| | - P Reix
- Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France; Centre de ressources et de compétences de la mucoviscidose, hôpital femme mère enfant, 69500 Bron, France; UMR 5558, équipe EMET, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France.
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Le Henaff C, Faria Da Cunha M, Hatton A, Tondelier D, Marty C, Collet C, Zarka M, Geoffroy V, Zatloukal K, Laplantine E, Edelman A, Sermet-Gaudelus I, Marie PJ. Genetic deletion of keratin 8 corrects the altered bone formation and osteopenia in a mouse model of cystic fibrosis. Hum Mol Genet 2016; 25:1281-93. [PMID: 26769674 DOI: 10.1093/hmg/ddw009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/06/2016] [Indexed: 12/23/2022] Open
Abstract
Patients with cystic fibrosis (CF) display low bone mass and alterations in bone formation. Mice carrying the F508del genetic mutation in the cystic fibrosis conductance regulator (Cftr) gene display reduced bone formation and decreased bone mass. However, the underlying molecular mechanisms leading to these skeletal defects are unknown, which precludes the development of an efficient anti-osteoporotic therapeutic strategy. Here we report a key role for the intermediate filament protein keratin 8 (Krt8), in the osteoblast dysfunctions in F508del-Cftr mice. We found that murine and human osteoblasts express Cftr and Krt8 at low levels. Genetic studies showed that Krt8 deletion (Krt8(-/-)) in F508del-Cftr mice increased the levels of circulating markers of bone formation, corrected the expression of osteoblast phenotypic genes, promoted trabecular bone formation and improved bone mass and microarchitecture. Mechanistically, Krt8 deletion in F508del-Cftr mice corrected overactive NF-κB signaling and decreased Wnt-β-catenin signaling induced by the F508del-Cftr mutation in osteoblasts. In vitro, treatment with compound 407, which specifically disrupts the Krt8-F508del-Cftr interaction in epithelial cells, corrected the abnormal NF-κB and Wnt-β-catenin signaling and the altered phenotypic gene expression in F508del-Cftr osteoblasts. In vivo, short-term treatment with 407 corrected the altered Wnt-β-catenin signaling and bone formation in F508del-Cftr mice. Collectively, the results show that genetic or pharmacologic targeting of Krt8 leads to correction of osteoblast dysfunctions, altered bone formation and osteopenia in F508del-Cftr mice, providing a therapeutic strategy targeting the Krt8-F508del-CFTR interaction to correct the abnormal bone formation and bone loss in cystic fibrosis.
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Affiliation(s)
- Carole Le Henaff
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Aurélie Hatton
- INSERM U-1151, Team 2, University Paris Descartes, Paris, France
| | | | - Caroline Marty
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Corinne Collet
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Mylène Zarka
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valérie Geoffroy
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Kurt Zatloukal
- Institute of Pathology, Medical University of Graz, Graz, Austria and
| | - Emmanuel Laplantine
- Laboratoire de Signalisation et Pathogenèse, Institut Pasteur, Paris, France
| | | | | | - Pierre J Marie
- INSERM UMR-1132, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France,
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Abstract
Osteoporosis is a metabolic bone disease characterized by loss of bone mass and strength, resulting in increased risk of fractures. It is classically divided into primary (post-menopausal or senile), secondary and idiopathic forms. There are many rare diseases, that cause directly or indirectly osteoporosis. The identification and classification of most of these rare causes of osteoporosis is crucial for the specialists in endocrinology and not, in order to prevent this bone complication and to provide for an early therapy. Several pathogenic mechanisms are involved, including various aspects of bone metabolism such as: decreased bone formation, increased bone resorption, altered calcium, phosphorus and/or vitamin D homeostasis, and abnormal collagen synthesis. In this review, less common forms of primary and secondary osteoporosis are described, specifying, if applicable: genetic causes, epidemiology, clinical features, and pathogenic mechanisms causing osteoporosis. A greater awareness of all rare causes of osteoporosis could reduce the number of cases classified as idiopathic osteoporosis and allow the introduction of appropriate and timely treatments.
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Affiliation(s)
- Gemma Marcucci
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Siwamogsatham O, Alvarez J, Tangpricha V. Diagnosis and treatment of endocrine comorbidities in patients with cystic fibrosis. Curr Opin Endocrinol Diabetes Obes 2014; 21:422-9. [PMID: 25105995 PMCID: PMC4326081 DOI: 10.1097/med.0000000000000096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on various relevant endocrine aspects of care in adolescents and adults with cystic fibrosis. RECENT FINDINGS As life expectancy in cystic fibrosis has continuously improved, endocrine complications have become more apparent. The common endocrine complications include cystic fibrosis related diabetes, cystic fibrosis related bone disease, vitamin D deficiency and poor growth and pubertal development. Thyroid and adrenal disorders have also been reported, although the prevalence appears to be less common. SUMMARY Endocrine diseases are an increasingly recognized complication that has a significant impact on the overall health of individuals with cystic fibrosis. This review summarizes the updated screening and management of endocrine diseases in the cystic fibrosis population.
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Affiliation(s)
- Oranan Siwamogsatham
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Samitivej Srinakarin Hospital, Bangkok Hospital Group, Bangkok, Thailand,
| | - Jessica Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA,
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Emory Adult Cystic Fibrosis Program, Emory Healthcare, Atlanta, GA
- Section of Endocrinology, Atlanta VA Medical Center, Decatur, GA, 101 Woodruff Circle NE- WMRB1301, Atlanta, GA 30322, Phone (404) 727-7254, Fax (404) 592-6257,
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13
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Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 13 January 2014.Additional searches of PubMed were performed on 13 January 2014. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Nine trials were identified and seven (with a total of 237 adult participants) were included.Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed to determine effects on fracture rate and survival.
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Affiliation(s)
- Louise S Conwell
- Lady Cilento Children's HospitalEndocrinology and DiabetesStanley StSouth BrisbaneBrisbaneQueenslandAustralia4101
- University of QueenslandSchool of Medicine and Queensland Children's Medical Research Institute300 Herston RoadHerstonQueenslandAustralia4006
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
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