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Aslam AA, Sinha IP, Southern KW. Ataluren and similar compounds (specific therapies for premature termination codon class I mutations) for cystic fibrosis. Cochrane Database Syst Rev 2023; 3:CD012040. [PMID: 36866921 PMCID: PMC9983356 DOI: 10.1002/14651858.cd012040.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a common, life-shortening, genetic disorder in populations of Northern European descent caused by the mutation of a single gene that codes for the production of the cystic fibrosis transmembrane conductance regulator (CFTR) protein. This protein coordinates the transport of salt (and bicarbonate) across cell surfaces, and the mutation most notably affects the airways. In the lungs of people with CF, the defective protein compromises mucociliary clearance and makes the airway prone to chronic infection and inflammation, damaging the structure of the airways and eventually leading to respiratory failure. In addition, abnormalities in the truncated CFTR protein lead to other systemic complications, including malnutrition, diabetes and subfertility. Five classes of mutation have been described, depending on the impact of the mutation on the processing of the CFTR protein in the cell. In class I mutations, premature termination codons prevent the production of any functional protein, resulting in severe CF. Therapies targeting class I mutations aim to enable the normal cellular mechanism to read through the mutation, potentially restoring the production of the CFTR protein. This could, in turn, normalise salt transport in the cells and decrease the chronic infection and inflammation that characterises lung disease in people with CF. This is an update of a previously published review. OBJECTIVES To evaluate the benefits and harms of ataluren and similar compounds on clinically important outcomes in people with CF with class I mutations (premature termination codons). SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, which is compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles. The last search of the Cochrane Cystic Fibrosis Trials Register was conducted on 7 March 2022. We searched clinical trial registries maintained by the European Medicines Agency, the US National Institutes of Health and the World Health Organization. The last search of the clinical trials registries was conducted on 4 October 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) of parallel design comparing ataluren and similar compounds (specific therapies for class I mutations) with placebo in people with CF who have at least one class I mutation. DATA COLLECTION AND ANALYSIS For the included trials, the review authors independently extracted data, assessed the risk of bias and evaluated the certainty of the evidence using GRADE; trial authors were contacted for additional data. MAIN RESULTS Our searches identified 56 references to 20 trials; of these, 18 trials were excluded. Both the included parallel RCTs compared ataluren to placebo for 48 weeks in 517 participants (males and females; age range six to 53 years) with CF who had at least one nonsense mutation (a type of class I mutation). The certainty of evidence and risk of bias assessments for the trials were moderate overall. Random sequence generation, allocation concealment and blinding of trial personnel were well documented; participant blinding was less clear. Some participant data were excluded from the analysis in one trial that also had a high risk of bias for selective outcome reporting. PTC Therapeutics Incorporated sponsored both trials with grant support from the Cystic Fibrosis Foundation, the US Food and Drug Administration's Office of Orphan Products Development and the National Institutes of Health. The trials reported no difference between treatment groups in terms of quality of life, and no improvement in respiratory function measures. Ataluren was associated with a higher rate of episodes of renal impairment (risk ratio 12.81, 95% confidence interval 2.46 to 66.65; P = 0.002; I2 = 0%; 2 trials, 517 participants). The trials reported no treatment effect for ataluren for the review's secondary outcomes of pulmonary exacerbation, computed tomography score, weight, body mass index and sweat chloride. No deaths were reported in the trials. The earlier trial performed a post hoc subgroup analysis of participants not receiving concomitant chronic inhaled tobramycin (n = 146). This analysis demonstrated favourable results for ataluren (n = 72) for the relative change in forced expiratory volume in one second (FEV1) per cent (%) predicted and pulmonary exacerbation rate. The later trial aimed to prospectively assess the efficacy of ataluren in participants not concomitantly receiving inhaled aminoglycosides, and found no difference between ataluren and placebo in FEV1 % predicted and pulmonary exacerbation rate. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to determine the effect of ataluren as a therapy for people with CF with class I mutations. One trial reported favourable results for ataluren in a post hoc subgroup analysis of participants not receiving chronic inhaled aminoglycosides, but these were not reproduced in the later trial, suggesting that the earlier results may have occurred by chance. Future trials should carefully assess for adverse events, notably renal impairment, and consider the possibility of drug interactions. Cross-over trials should be avoided, given the potential for the treatment to change the natural history of CF.
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Affiliation(s)
- Aisha A Aslam
- The Children's Hospital, Royal London Hospital, London, UK
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Aguib Y, Allouba M, Walsh R, Ibrahim AM, Halawa S, Afify A, Hosny M, Theotokis PI, Galal A, Elshorbagy S, Roshdy M, Kassem HS, Ellithy A, Buchan R, Whiffin N, Anwer S, Cook SA, Moustafa A, ElGuindy A, Ware JS, Barton PJR, Yacoub M. New Variant With a Previously Unrecognized Mechanism of Pathogenicity in Hypertrophic Cardiomyopathy. Circulation 2021; 144:754-757. [PMID: 34460321 PMCID: PMC8389346 DOI: 10.1161/circulationaha.120.048295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasmine Aguib
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Mona Allouba
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Roddy Walsh
- Department of Experimental Cardiology, Amsterdam UMC, the Netherlands (R.W.)
| | - Ayman M Ibrahim
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Faculty of Science, Cairo University, Egypt (A.M.I.)
| | - Sarah Halawa
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Biotechnology Graduate Program (S.H., A.M.), American University in Cairo, New Cairo, Egypt
| | - Alaa Afify
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Mohammed Hosny
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Cardiology Department, Faculty of Medicine, Cairo University, Egypt (M.H.)
| | - Pantazis I Theotokis
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Aya Galal
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Sara Elshorbagy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Mohamed Roshdy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Heba S Kassem
- Clinical Genomics Center, Alexandria Faculty of Medicine, Egypt (H.S.K.)
| | - Amany Ellithy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Rachel Buchan
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.)
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (N.W.)
| | - Shehab Anwer
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Stuart A Cook
- Duke-National University of Singapore Medical School (S.A.C.).,National Heart Centre Singapore (S.A.C.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Ahmed Moustafa
- Biotechnology Graduate Program (S.H., A.M.), American University in Cairo, New Cairo, Egypt.,Department of Biology (A.M.), American University in Cairo, New Cairo, Egypt
| | - Ahmed ElGuindy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Paul J R Barton
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Magdi Yacoub
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Harefield Heart Science Centre, United Kingdom (M.Y.)
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Cefalù AB, Spina R, Noto D, Valenti V, Ingrassia V, Giammanco A, Panno MD, Ganci A, Barbagallo CM, Averna MR. Novel CREB3L3 Nonsense Mutation in a Family With Dominant Hypertriglyceridemia. Arterioscler Thromb Vasc Biol 2015; 35:2694-9. [PMID: 26427795 DOI: 10.1161/atvbaha.115.306170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/18/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cyclic AMP responsive element-binding protein 3-like 3 (CREB3L3) is a novel candidate gene for dominant hypertriglyceridemia. To date, only 4 kindred with dominant hypertriglyceridemia have been found to be carriers of 2 nonsense mutations in CREB3L3 gene (245fs and W46X). We investigated a family in which hypertriglyceridemia displayed an autosomal dominant pattern of inheritance. APPROACH AND RESULTS The proband was a 49-year-old woman with high plasma triglycerides (≤1300 mg/dL; 14.68 mmol/L). Her father had a history of moderate hypertriglyceridemia, and her 51-year-old brother had triglycerides levels as high as 1600 mg/dL (18.06 mmol/L). To identify the causal mutation in this family, we analyzed the candidate genes of recessive and dominant forms of primary hypertriglyceridemia by direct sequencing. The sequencing of CREB3L3 gene led to the discovery of a novel minute frame shift mutation in exon 3 of CREB3L3 gene, predicted to result in the formation of a truncated protein devoid of function (c.359delG-p.K120fsX20). Heterozygosity for the c.359delG mutation resulted in a severe phenotype occurring later in life in the proband and her brother and a good response to diet and a hypotriglyceridemic treatment. The same mutation was detected in a 13-year-old daughter who to date is normotriglyceridemic. CONCLUSIONS We have identified a novel pathogenic mutation in CREB3L3 gene in a family with dominant hypertriglyceridemia with a variable pattern of penetrance.
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Affiliation(s)
- Angelo B Cefalù
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Rossella Spina
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Davide Noto
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Vincenza Valenti
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Valeria Ingrassia
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Antonina Giammanco
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Maria D Panno
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Antonina Ganci
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Carlo M Barbagallo
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.)
| | - Maurizio R Averna
- From the Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), University of Palermo, Palermo, Italy (A.B.C., R.S., D.N., V.I., A. Giammanco, M.D.P., A. Ganci, C.M.B., M.R.A.); and Molecular Biology Diagnostic Laboratory, Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP "Paolo Giaccone", Palermo, Italy (A.B.C., R.S., D.N., V.V., V.I., M.R.A.).
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