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Barry PJ, Simmonds NJ. Diagnosing Cystic Fibrosis in Adults. Semin Respir Crit Care Med 2023; 44:242-251. [PMID: 36623819 DOI: 10.1055/s-0042-1759881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diagnosing cystic fibrosis (CF) in adulthood is not a rare occurrence for CF centers despite the popular belief that the diagnosis is achieved almost universally in childhood by means of newborn screening or early clinical presentation. The purpose of this review article is to highlight specific considerations of adult diagnosis of CF. Obtaining a diagnosis of CF at any age is exceptionally important to ensure optimal treatment, monitoring, and support. In the new era of more personalized treatment with the advent of transformative therapies targeting the underlying protein defect, accurate diagnosis is of increasing importance. This review highlights the diagnostic algorithm leading to a new diagnosis of CF in adults. The diagnosis is usually confirmed in the presence of a compatible clinical presentation, evidence of cystic fibrosis transmembrane conductance regulator (CFTR) protein dysfunction, and/or identification of variants in the CFTR gene believed to alter protein function. Achieving the diagnosis, however, is not always straightforward as CFTR protein function exists on a continuum with different organs displaying varying sensitivity to diminution in function. We highlight the current knowledge regarding the epidemiology of CF diagnosed in adults and outline the various clinical presentations, including pulmonary and extrapulmonary, which are more common in this population. We expand on the stepwise testing procedures that lead to diagnosis, paying particular attention to additional levels of testing which may be required to achieve an accurate diagnosis. There continues to be an important need for both pulmonary and other specialists to be aware of the potential for later presentation of CF, as the improvements in treatment over decades have had large positive impacts on prognosis for people with this condition.
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Affiliation(s)
- Peter J Barry
- Manchester Adult Cystic Fibrosis Centre, Manchester University National Health Service Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Nicholas J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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2
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Organoid Technology and Its Role for Theratyping Applications in Cystic Fibrosis. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010004. [PMID: 36670555 PMCID: PMC9856584 DOI: 10.3390/children10010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Cystic fibrosis (CF) is a autosomal recessive, multisystemic disease caused by different mutations in the CFTR gene encoding CF transmembrane conductance regulator. Although symptom management is important to avoid complications, the approval of CFTR modulator drugs in the clinic has demonstrated significant improvements by targeting the primary molecular defect of CF and thereby preventing problems related to CFTR deficiency or dysfunction. CFTR modulator therapies have positively changed the patients' quality of life, especially for those who start their use at the onset of the disease. Due to early diagnosis with the implementation of newborn screening programs and considerable progress in the treatment options, nowadays pediatric mortality was dramatically reduced. In any case, the main obstacle to treat CF is to predict the drug response of patients due to genetic complexity and heterogeneity. Advances in 3D culture systems have led to the extrapolation of disease modeling and individual drug response in vitro by producing mini organs called "organoids" easily obtained from nasal and rectal mucosa biopsies. In this review, we focus primarily on patient-derived intestinal organoids used as in vitro model for CF disease. Organoids combine high-validity of outcomes with a high throughput, thus enabling CF disease classification, drug development and treatment optimization in a personalized manner.
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Berg P, Sorensen MV, Rousing AQ, Vebert Olesen H, Jensen-Fangel S, Jeppesen M, Leipziger J. Challenged Urine Bicarbonate Excretion as a Measure of Cystic Fibrosis Transmembrane Conductance Regulator Function in Cystic Fibrosis. Ann Intern Med 2022; 175:1543-1551. [PMID: 36315944 DOI: 10.7326/m22-1741] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In cystic fibrosis (CF), renal base excretion is impaired. Accordingly, challenged urine bicarbonate excretion may be an in vivo biomarker of cystic fibrosis transmembrane conductance regulator (CFTR) function. OBJECTIVE To evaluate the association between challenged bicarbonate excretion and clinical characteristics at baseline, quantify the CFTR modulator drug elexacaftor/tezacaftor/ivacaftor-induced changes of challenged bicarbonate excretion after 6 months of treatment, and characterize the intraindividual variation in healthy adults. DESIGN Prospective observational study. SETTING Cystic fibrosis clinic, Aarhus University Hospital, Denmark. PATIENTS Fifty adult patients with CF starting CFTR modulator therapy with elexacaftor/tezacaftor/ivacaftor between May 2020 and June 2021. MEASUREMENTS Quantification of urine bicarbonate excretion after an acute oral sodium bicarbonate challenge before and 6 months after elexacaftor/tezacaftor/ivacaftor treatment. RESULTS At baseline, challenged urine bicarbonate excretion was associated with several CF disease characteristics. Bicarbonate excretion was higher in patients with residual function mutations. A higher bicarbonate excretion was associated with better lung function, pancreatic sufficiency, and lower relative risk for chronic pseudomonas infections. Elexacaftor/tezacaftor/ivacaftor treatment increased bicarbonate excretion by 3.9 mmol/3 h (95% CI, 1.6 to 6.1 mmol/3 h), reaching about 70% of that seen in healthy control participants. In healthy control participants, individual bicarbonate excretion at each visit correlated with the individual mean bicarbonate excretion. The median coefficient of variation was 31%. LIMITATION Single-center study without a placebo-controlled group. CONCLUSION Although further studies are needed to address the performance and sensitivity of this approach, this early-stage evaluation shows that challenged urine bicarbonate excretion may offer a new, simple, and safe quantification of CFTR function and the extent of its pharmacologic improvement. Elexacaftor/tezacaftor/ivacaftor partially restores renal CFTR function in patients with CF, likely resulting in decreased risk for electrolyte disorders and metabolic alkalosis. PRIMARY FUNDING SOURCE Innovation Fund Denmark.
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Affiliation(s)
- Peder Berg
- Department of Biomedicine, Aarhus University, Aarhus, Denmark (P.B., M.V.S., A.Q.R., J.L.)
| | - Mads V Sorensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark (P.B., M.V.S., A.Q.R., J.L.)
| | - Amalie Quist Rousing
- Department of Biomedicine, Aarhus University, Aarhus, Denmark (P.B., M.V.S., A.Q.R., J.L.)
| | - Hanne Vebert Olesen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark (H.V.O.)
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (S.J., M.J.)
| | - Majbritt Jeppesen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (S.J., M.J.)
| | - Jens Leipziger
- Department of Biomedicine, Aarhus University, Aarhus, Denmark (P.B., M.V.S., A.Q.R., J.L.)
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Graeber SY, Vitzthum C, Mall MA. Potential of Intestinal Current Measurement for Personalized Treatment of Patients with Cystic Fibrosis. J Pers Med 2021; 11:jpm11050384. [PMID: 34066648 PMCID: PMC8151208 DOI: 10.3390/jpm11050384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022] Open
Abstract
Refinement of personalized treatment of cystic fibrosis (CF) with emerging medicines targeting the CF basic defect will likely benefit from biomarkers sensitive to detect improvement of cystic fibrosis transmembrane conductance regulator (CFTR) function in individual patients. Intestinal current measurement (ICM) is a technique that enables quantitative assessment of CFTR chloride channel function in rectal tissues or other intestinal epithelia. ICM was originally developed to study the CF ion transport defect in the intestine and has been established as a sensitive biomarker of CFTR function and diagnostic test for CF. With the emergence of CFTR-directed therapeutics, ICM has become an important tool to estimate the level of rescue of CFTR function achieved by approved CFTR modulators, both at the level of CFTR genotype groups, as well as individual patients with CF. In combination with preclinical patient-derived cell culture models, ICM may aid the development of targeted therapies for patients with rare CFTR mutations. Here, we review the principles of ICM and examine how this CFTR biomarker may be used to support diagnostic testing and enhance personalized medicine for individual patients with common as well as rare CFTR mutations in the new era of medicines targeting the underlying cause of CF.
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Affiliation(s)
- Simon Y. Graeber
- Charité—Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, 13353 Berlin, Germany; (S.Y.G.); (C.V.)
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Centre for Lung Research (DZL), 13353 Berlin, Germany
| | - Constanze Vitzthum
- Charité—Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, 13353 Berlin, Germany; (S.Y.G.); (C.V.)
- German Centre for Lung Research (DZL), 13353 Berlin, Germany
| | - Marcus A. Mall
- Charité—Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, 13353 Berlin, Germany; (S.Y.G.); (C.V.)
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Centre for Lung Research (DZL), 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-(30)-450-566-182; Fax: +49-(30)-450-566-931
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5
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Naehrlich L. Have courage in using nasal potential difference for diagnostic decisions and clinical research. J Cyst Fibros 2020; 19:507-508. [PMID: 32593372 DOI: 10.1016/j.jcf.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Feulgenstrasse 12, D-35385 Giessen, Germany.
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6
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Wiencek JR, Lo SF. Advances in the Diagnosis and Management of Cystic Fibrosis in the Genomic Era. Clin Chem 2018; 64:898-908. [DOI: 10.1373/clinchem.2017.274670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/17/2018] [Indexed: 01/08/2023]
Abstract
Abstract
BACKGROUND
Cystic fibrosis (CF) is a complex autosomal recessive disease that continues to present unique diagnostic challenges. Because CF was first described in 1938, there has been a substantial growth of genetic and phenotypic information about the disorder. During the past few years, as more evidence has become available, a consortium of international experts determined that the 2008 guidelines from the CF Foundation needed to be reviewed and updated.
CONTENT
The goal of this review is to highlight the latest advances in CF multidisciplinary care, together with the recent updates to the 2017 CF Foundation diagnostic guidelines.
SUMMARY
Data from newborn screening programs, patient registries, clinical databases, and functional research have led to a better understanding of the CF transmembrane conductance regulator (CFTR) gene. Recent consensus guidelines have provided recommendations for clinicians and laboratorians to better assist with interpretation of disease status and related CF mutations. The highly recommended Clinical and Functional Translation of CFTR project should be the first resource in the evaluation of disease severity for CF mutations. Screen-positive newborns and patients with high clinical suspicion for CF are always recommended to undergo confirmatory sweat chloride testing with interpretations based on updated reference intervals. Every patient diagnosed with CF should receive genotyping, as novel molecular therapies are becoming standard of practice. The future of CF management must consider healthcare system disparities as CF transitions from a historically childhood disease to a predominantly adult epidemic.
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Affiliation(s)
- Joesph R Wiencek
- Division of Laboratory Medicine, Department of Pathology, University of Virginia School of Medicine and Health System, Charlottesville, VA
| | - Stanley F Lo
- Department of Pathology, Medical College of Wisconsin and Department of Pathology and Laboratory Medicine, Children's Hospital of Wisconsin, Milwaukee, WI
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De Boeck K, Vermeulen F, Dupont L. The diagnosis of cystic fibrosis. Presse Med 2017; 46:e97-e108. [PMID: 28576637 DOI: 10.1016/j.lpm.2017.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 01/09/2023] Open
Abstract
Establishing the diagnosis of cystic fibrosis (CF) is straight forward in the majority of patients: they present with a clear clinical picture (most frequently chronic respiratory symptoms plus malabsorption), the sweat chloride value is>60mmol/L and two known disease causing CFTR mutations are identified. In less than 5% of subjects, mainly those with a milder or limited phenotype, the diagnostic process is more complex, because initial diagnostic test results are inconclusive: sweat chloride concentration in the intermediate range, less than 2 CF causing mutations identified or both. These patients should be referred to expert centers where bioassays of CFTR function like nasal potential difference measurement or intestinal current measurement can be done. Still, in some patients, despite symptoms compatible with CF and some indication of CFTR dysfunction (e.g. only intermediate sweat chloride value), diagnostic criteria are not met (e.g. only 1 CFTR mutation identified). For these subjects, the term CFTR related disorder (CFTR-RD) is used. Patients with disseminated bronchiectasis, congenital bilateral absence of the vas deferens and acute or recurrent pancreatitis may fall in this category. CF has a very wide disease spectrum and increasingly the diagnosis is being made during adult life, mainly in subjects with milder phenotypes. In many countries, nationwide CF newborn screening (NBS) has been introduced. In screen positive babies, the diagnosis of CF must be confirmed by a sweat test demonstrating a sweat chloride concentration above 60mmol/L. To achieve the benefit of NBS, every baby in whom the diagnosis of CF is confirmed must receive immediate follow-up and treatment in a CF reference center. CF NBS is not full proof: some diagnoses will be missed and in some babies the diagnosis cannot be confirmed nor ruled out with certainty. Screening algorithms that include gene sequencing will detect a high number of such babies that are screen positive with an inconclusive diagnosis (CFSPID). Even in 2016, the most reliable and widely available diagnostic test for CF is the measurement of chloride concentration in sweat. The method of choice is sweat induction by pilocarpine iontophoresis, followed by sweat collection on a gauze or filter paper or in a Macroduct coil. Since mutation specific therapies have become available, it is important to identify the mutations responsible for CF in each individual patient.
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Affiliation(s)
- Kris De Boeck
- University of Leuven, Department of Pulmonology, 3000 Leuven, Belgium.
| | | | - Lieven Dupont
- University of Leuven, Department of Pulmonology, Leuven, Belgium
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Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, Howenstine M, McColley SA, Rock M, Rosenfeld M, Sermet-Gaudelus I, Southern KW, Marshall BC, Sosnay PR. Diagnosis of Cystic Fibrosis: Consensus Guidelines from the Cystic Fibrosis Foundation. J Pediatr 2017; 181S:S4-S15.e1. [PMID: 28129811 DOI: 10.1016/j.jpeds.2016.09.064] [Citation(s) in RCA: 481] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cystic fibrosis (CF), caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, continues to present diagnostic challenges. Newborn screening and an evolving understanding of CF genetics have prompted a reconsideration of the diagnosis criteria. STUDY DESIGN To improve diagnosis and achieve standardized definitions worldwide, the CF Foundation convened a committee of 32 experts in CF diagnosis from 9 countries to develop clear and actionable consensus guidelines on the diagnosis of CF and to clarify diagnostic criteria and terminology for other disorders associated with CFTR mutations. An a priori threshold of ≥80% affirmative votes was required for acceptance of each recommendation statement. RESULTS After reviewing relevant literature, the committee convened to review evidence and cases. Following the conference, consensus statements were developed by an executive subcommittee. The entire consensus committee voted and approved 27 of 28 statements, 7 of which needed revisions and a second round of voting. CONCLUSIONS It is recommended that diagnoses associated with CFTR mutations in all individuals, from newborn to adult, be established by evaluation of CFTR function with a sweat chloride test. The latest mutation classifications annotated in the Clinical and Functional Translation of CFTR project (http://www.cftr2.org/index.php) should be used to aid in diagnosis. Newborns with a high immunoreactive trypsinogen level and inconclusive CFTR functional and genetic testing may be designated CFTR-related metabolic syndrome or CF screen positive, inconclusive diagnosis; these terms are now merged and equivalent, and CFTR-related metabolic syndrome/CF screen positive, inconclusive diagnosis may be used. International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for use in diagnoses associated with CFTR mutations are included.
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Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Clement L Ren
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | | | - Frank Accurso
- Section of Pediatric Pulmonology, Colorado School of Public Health, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Nico Derichs
- CFTR Biomarker Center and Translational CF Research Group, CF Center, Pediatric Pulmonology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michelle Howenstine
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michael Rock
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Margaret Rosenfeld
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Isabelle Sermet-Gaudelus
- Centres de Ressources et de Compétences pour la Mucoviscidose, Institut Necker Enfants Malades/INSERM U1151, Hôpital Necker Enfants Malades, Paris, France
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Institute in the Park, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Patrick R Sosnay
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Comparison of Nasal Potential Difference and Intestinal Current Measurements as Surrogate Markers for CFTR Function. J Pediatr Gastroenterol Nutr 2016; 63:e92-e97. [PMID: 27496797 DOI: 10.1097/mpg.0000000000001366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Nasal potential difference (NPD) measurement is part of the diagnostic criteria for cystic fibrosis (CF) and now used routinely as an endpoint in clinical trials of correcting the basic defect in CF. Intestinal current measurement (ICM), measured ex vivo on a rectal biopsy, has been used to study cystic fibrosis transmembrane conductance regulator (CFTR) function but has not been compared to NPD in the same subject in adults and children. The aim of the study is to evaluate the potential usefulness of ICM as a marker of CFTR function for treatment studies compared NPD in patients with CF and in healthy control subjects. METHODS ICM and NPD were performed on healthy controls and patients with CF. The healthy adults were individuals undergoing routine screening colonoscopy at the Beth Israel Deaconess Medical Center. The healthy children were undergoing colonoscopy for suspicion of inflammation in Hadassah Hebrew University Medical Center. The CF adults were recruited from Boston Children's Hospital CF Center and CF Center Worcester Mass, the children with CF from Hadassah CF Center. RESULTS ICM measurements in healthy control subjects (n = 16) demonstrated a mean (±SE) carbachol response of 16.0 (2.2) μA/cm, histamine response of 13.2 (2.1) μA/cm and a forskolin response of 6.3 (2.0) μA/cm. Basal NPD of -15.9 (1.9) and response to Cl free + isoproterenol of -13.8 (2.0). These responses were inverted in CF subjects (n = 12) for ICM parameters with carbachol response of -3.0 (0.5) μA/cm, histamine -1.0 (0.8) μA/cm and a forskolin response of 0.5 (0.3) and also for NPD parameters; basal NPD of -42.2 (4.3) and response to Cl free + isoproterenol of 4.3 (0.7). Pearson correlation test showed the comparability of ICM and NPD in assessing CFTR function. CONCLUSIONS ICM is equivalent to NPD in the ability to distinguish patients with CF from controls and could be used as surrogate markers of CFTR activity in treatment protocols.
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Groves T, Robinson P, Fitzgerald DA. Question 7: For an infant with an equivocal sweat chloride following newborn screening, how likely is a diagnosis of cystic fibrosis? Paediatr Respir Rev 2016; 20:48-50. [PMID: 26724140 DOI: 10.1016/j.prrv.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Tyler Groves
- University of Sydney, Discipline of Paediatrics and Child Health, University of Sydney; Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney.
| | - Paul Robinson
- University of Sydney, Discipline of Paediatrics and Child Health, University of Sydney; Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney
| | - Dominic A Fitzgerald
- University of Sydney, Discipline of Paediatrics and Child Health, University of Sydney; Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney
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11
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Farahmand F, Tajdini P, Falahi G, Shams S, Mahmoudi S. Evaluation of Serum Adenosine Deaminase in Cystic Fibrosis Patients in an Iranian Referral Hospital. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e2246. [PMID: 27617063 PMCID: PMC4987630 DOI: 10.5812/ijp.2246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/22/2015] [Accepted: 05/05/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adenosine, a signaling nucleoside, is controlled in part by the enzyme adenosine deaminase (ADA). There are rare reports on the role of adenosine levels and ADA in cystic fibrosis (CF) patients. OBJECTIVES The aim of this study was to assess serum ADA in CF patients in order to find whether the severity of lung disease in CF is related to significant changes of ADA or not. PATIENTS AND METHODS Venous blood serum ADA was measured in CF patients (3-15 years) and 49 healthy children (3-15 years) referred to Children's Medical Center. Classification of respiratory and gastrointestinal disease severity in CF patients as well as Body Mass Index (BMI) was performed. The results were compared with values obtained from healthy children matched for age and gender. RESULTS This study included 49 children of both genders (20 females and 29 males) with CF (mean age: 6.36 ± 2.22 years). Mean serum ADA in CF patients group and control group was 9.38 ± 2.72 and 16.04 ± 1.27, respectively (P value = 0.001). Mean serum ADA in CF patients with normal BMI was higher than in patients with low BMI (P value = 0.002). CONCLUSIONS In this study the lower serum level of ADA was seen in CF patients compared to control group. The clinical symptoms, especially respiratory symptoms, in CF patients might be associated with reduction of serum ADA and rising serum adenosine; therefore, further studies on the use of ADA enzyme therapy in CF patients are highly recommended.
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Affiliation(s)
- Fatemeh Farahmand
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Parisa Tajdini
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Gholamhossein Falahi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Sedigheh Shams
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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12
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Hegyi P, Wilschanski M, Muallem S, Lukacs GL, Sahin-Tóth M, Uc A, Gray MA, Rakonczay Z, Maléth J. CFTR: A New Horizon in the Pathomechanism and Treatment of Pancreatitis. Rev Physiol Biochem Pharmacol 2016; 170:37-66. [PMID: 26856995 DOI: 10.1007/112_2015_5002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) is an ion channel that conducts chloride and bicarbonate ions across epithelial cell membranes. Mutations in the CFTR gene diminish the ion channel function and lead to impaired epithelial fluid transport in multiple organs such as the lung and the pancreas resulting in cystic fibrosis. Heterozygous carriers of CFTR mutations do not develop cystic fibrosis but exhibit increased risk for pancreatitis and associated pancreatic damage characterized by elevated mucus levels, fibrosis, and cyst formation. Importantly, recent studies demonstrated that pancreatitis causing insults, such as alcohol, smoking, or bile acids, strongly inhibit CFTR function. Furthermore, human studies showed reduced levels of CFTR expression and function in all forms of pancreatitis. These findings indicate that impairment of CFTR is critical in the development of pancreatitis; therefore, correcting CFTR function could be the first specific therapy in pancreatitis. In this review, we summarize recent advances in the field and discuss new possibilities for the treatment of pancreatitis.
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Affiliation(s)
- Péter Hegyi
- Institute for Translational Medicine and 1st Department of Medicine, University of Pécs, Pécs, Hungary.
- MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary.
- First Department of Medicine, University of Szeged, Szeged, Hungary.
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Shmuel Muallem
- National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
| | | | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Aliye Uc
- Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Michael A Gray
- Institute for Cell & Molecular Biosciences, University Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - József Maléth
- First Department of Medicine, University of Szeged, Szeged, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szeged, Hungary
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13
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van Koningsbruggen-Rietschel S, Naehrlich L. Cystic fibrosis transmembrane conductance regulator biomarkers in ‘real life’: can we evaluate individual efficacy of cystic fibrosis transmembrane conductance regulator therapy? Ther Adv Respir Dis 2015; 9:198-200. [DOI: 10.1177/1753465815579364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany
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