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Aluma BEB, Reiter J, Efrati O, Bezalel Y, Keler S, Ashkenazi M, Dagan A, Buchnik Y, Sadras I, Cohen-Cymberknoh M. Clinical efficacy of CFTR modulator therapy in people with cystic fibrosis carrying the I1234V mutation. J Cyst Fibros 2024:S1569-1993(24)00019-5. [PMID: 38443268 DOI: 10.1016/j.jcf.2024.02.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/21/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The cystic fibrosis transmembrane conductance regulator (CFTR) mutation I1234V (I1234V, p.Ile1234Val, c.3700A>G), is a missense-mutation that creates a cryptic splice site, with the formation of a protein lacking 6 amino acids, that is misfolded and misprocessed. The in vitro effects of CFTR modulator (CFTRm) therapies on human bronchial cell models and intestinal organoids carrying this mutation are conflicting. The aim of this study was therefore to explore the clinical efficacy of CFTRm in people with cystic fibrosis (pwCF) carrying this mutation. METHODS This was a retrospective descriptive study of the clinical records of homozygous and compound heterozygous (none F508del) pwCF, for the I1234V mutation, that received CFTRm. Parameters explored were body mass index (BMI), forced expiratory volume in one second percent predicted (FEV1%), lung clearance index (LCI) and quantitative sweat chloride measurements. RESULTS Mean age was 38.6 ± 14 years (range 21-60). Two subjects were homozygous and five compound heterozygous, with minimal function mutations. Four were pancreatic insufficient and three pancreatic sufficient. The two homozygous subjects received Tezacaftor/Ivacaftor, the remaining Elexacaftor/Tezacaftor/Ivacaftor (ETI); treatment ranged from 6 to 12 months. Mean BMI score increased from 21.7 ± 1.3 to 23.6 ± 2.1 kg/m2 (p = 0.04); FEV1(%pred) increased by 20.14±10.2while mean change in FEV1 in the year prior to CFTRm initiation was -0.14±1.18 (p = 0.0001). Additionally, LCI 2.5% decreased from 18.7 to 14.5 (p = 0.07); sweat chloride decreased from 116±10 to 90±17 mEq/L (p = 0.017) and chronic pseudomonas airway infection was eradicated in one subject. CONCLUSIONS This study supports a clinical benefit for CFTRm therapy in pwCF carrying the I1234V mutation.
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Affiliation(s)
- Bat El Bar Aluma
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Joel Reiter
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Bezalel
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Keler
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Ashkenazi
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Dagan
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Buchnik
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Lily and Edmond Safra Children's Hospital, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Sadras
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonary Unit and Cystic fibrosis Center, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Kagan M, Semo-Oz R, Ben Moshe Y, Atias-Varon D, Tirosh I, Stern-Zimmer M, Eliyahu A, Raas-Rothschild A, Bivas M, Shlomovitz O, Chorin O, Rock R, Tzadok M, Ben-Zeev B, Heimer G, Bolkier Y, Gruber N, Dagan A, Bar Aluma BE, Pessach IM, Rechavi G, Barel O, Pode-Shakked B, Anikster Y, Vivante A. Clinical impact of exome sequencing in the setting of a general pediatric ward for hospitalized children with suspected genetic disorders. Front Genet 2023; 13:1018062. [PMID: 36699461 PMCID: PMC9868164 DOI: 10.3389/fgene.2022.1018062] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Background: Genetic conditions contribute a significant portion of disease etiologies in children admitted to general pediatric wards worldwide. While exome sequencing (ES) has improved clinical diagnosis and management over a variety of pediatric subspecialties, it is not yet routinely used by general pediatric hospitalists. We aim to investigate the impact of exome sequencing in sequencing-naive children suspected of having monogenic disorders while receiving inpatient care. Methods: We prospectively employed exome sequencing in children admitted to the general pediatric inpatient service at a large tertiary medical center in Israel. Genetic analysis was triggered by general and/or subspecialist pediatricians who were part of the primary inpatient team. We determined the diagnostic yield among children who were referred for exome sequencing and observed the effects of genetic diagnosis on medical care. Results: A total of fifty probands were evaluated and exome sequenced during the study period. The most common phenotypes included were neurodevelopmental (56%), gastrointestinal (34%), and congenital cardiac anomalies (24%). A molecular diagnosis was reached in 38% of patients. Among seven patients (37%), the molecular genetic diagnosis influenced subsequent clinical management already during admission or shortly following discharge. Conclusion: We identified a significant fraction of genetic etiologies among undiagnosed children admitted to the general pediatric ward. Our results support that early application of exome sequencing may be maximized by pediatric hospitalists' high index of suspicion for an underlying genetic etiology, prompting an in-house genetic evaluation. This framework should include a multidisciplinary co-management approach of the primary care team working alongside with subspecialties, geneticists and bioinformaticians.
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Affiliation(s)
- Maayan Kagan
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rotem Semo-Oz
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Rheumatology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yishay Ben Moshe
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Danit Atias-Varon
- Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Irit Tirosh
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Rheumatology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviva Eliyahu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Annick Raas-Rothschild
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maayan Bivas
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Shlomovitz
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Odelia Chorin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rachel Rock
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel,The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Tzadok
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Bruria Ben-Zeev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gali Heimer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Pediatric Neurology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yoav Bolkier
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Heart Institute, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noah Gruber
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Adi Dagan
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Bat El Bar Aluma
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Itai M. Pessach
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Department of Pediatric Intensive Care, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gideon Rechavi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,Sheba Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ortal Barel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,The Genomics Unit, Sheba Cancer Research Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ben Pode-Shakked
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yair Anikster
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel-Hashomer, Israel,Metabolic Disease Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel,Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel,*Correspondence: Asaf Vivante,
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Ashkenazi M, Bak A, Sarouk I, Bar Aluma BE, Dagan A, Bezalel Y, Vilozni D, Efrati O. Spontaneous pneumothorax-When do we need to intervene? Clin Respir J 2021; 15:967-972. [PMID: 33998780 DOI: 10.1111/crj.13400] [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] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumothorax can be classified as traumatic, iatrogenic or spontaneous (SP), which can be subdivided into primary spontaneous pneumothorax (PSP), a condition without preexisting lung disease, or secondary spontaneous pneumothorax (SSP) a complication of a preexisting lung disease. Recurrence rate of PSP is 30% whereas for SSP rate is unknown. This article explores the experience of a tertiary center over 20 years. METHODS A retrospective case review of patients hospitalized with pneumothorax to investigate the natural history and treatment of SP in a young population in a single tertiary center was conducted. A search of the digital archive (going back to 01/01/1995) of Sheba Medical Center identified hospitalized patients below the age of 40. RESULTS The database was composed of the records of 750 patients (612 males, 138 females) who were hospitalized. The recurrence risk for SP after nonoperative treatment was significantly higher. Women were found to have an increased risk of SSP when having SP (OR 2.78). Asthma was the most prevalent disease causing SSP in young people. CONCLUSIONS In this large cohort, we found that operative procedure has clear protective effect from recurrence in SP, so surgery should be positively considered when treating SP in hospitalized patients. Among young people and particularly in pediatric patients, when females have a SP, we strongly recommend looking for primary lung disease. More studies are needed to determine the risk factors and produce clear guidelines regarding surgery as first treatment.
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Affiliation(s)
- Moshe Ashkenazi
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Bak
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ifat Sarouk
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bat El Bar Aluma
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Dagan
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Bezalel
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Vilozni
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Efrati
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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5
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Ashkenazi M, Sity S, Sarouk I, Bar Aluma BE, Dagan A, Bezalel Y, Bentur L, De Boeck K, Efrati O. Omalizumab in allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. J Asthma Allergy 2018; 11:101-107. [PMID: 29950869 PMCID: PMC6016275 DOI: 10.2147/jaa.s156049] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterized by a Th2 response, serum eosinophilia, and increased total serum IgE to Aspergillus fumigatus. ABPA occurs in cystic fibrosis (CF) and asthma. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Previous studies reported borderline results when treating ABPA with omalizumab. Methods A retrospective study to investigate the efficacy of omalizumab in the treatment of ABPA in CF patients was conducted at 3 CF centers in Israel and Belgium. Data were obtained from the digital archive. We measured 4 outcome parameters: forced expiratory volume in 1 second, body mass index, pulmonary exacerbations, and steroid sparing. Results The database was composed on the records of 9 patients. None of the outcome parameters showed any improvement. A favorable outcome was observed in patients with higher levels of posttreatment total IgE than those with lower levels. CF-related diabetes and male gender showed trends for poorer outcomes. Conclusion No benefits were detected on treating ABPA in CF with omlaizumb. Monitoring the total IgE was not helpful. A prospective randomized double-blind study is needed.
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Affiliation(s)
- Moshe Ashkenazi
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saray Sity
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sarouk
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bat El Bar Aluma
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Dagan
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Bezalel
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lea Bentur
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Kris De Boeck
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - Ori Efrati
- Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Behar DM, Inbar O, Shteinberg M, Gur M, Mussaffi H, Shoseyov D, Ashkenazi M, Alkrinawi S, Bormans C, Hakim F, Mei-Zahav M, Cohen-Cymberknoh M, Dagan A, Prais D, Sarouk I, Stafler P, Bar Aluma BE, Akler G, Picard E, Aviram M, Efrati O, Livnat G, Rivlin J, Bentur L, Blau H, Kerem E, Singer A. Nationwide genetic analysis for molecularly unresolved cystic fibrosis patients in a multiethnic society: implications for preconception carrier screening. Mol Genet Genomic Med 2017; 5:223-236. [PMID: 28546993 PMCID: PMC5441412 DOI: 10.1002/mgg3.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/07/2017] [Accepted: 01/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Preconception carrier screening for cystic fibrosis (CF) is usually performed using ethnically targeted panels of selected mutations. This has been recently challenged by the use of expanded, ethnically indifferent, pan‐population panels. Israel is characterized by genetically heterogeneous populations carrying a wide range of CFTR mutations. To assess the potential of expanding the current Israeli preconception screening program, we sought the subset of molecularly unresolved CF patients listed in the Israeli CF data registry comprising ~650 patients. Methods An Israeli nationwide genotyping of 152 CF cases, representing 176 patients lacking molecular diagnosis, was conducted. Molecular analysis included Sanger sequencing for all exons and splice sites, multiplex ligation probe amplification (MLPA), and next‐generation sequencing of the poly‐T/TG tracts. Results We identified 54 different mutations, of which only 16 overlapped the 22 mutations included in the Israeli preconception screening program. A total of 29/54 (53.7%) mutations were already listed as CF causing by the CFTR2 database, and only 4/54 (7.4%) were novel. Molecular diagnosis was reached in 78/152 (51.3%) cases. Prenatal diagnosis of 24/78 (30.8%) cases could have been achieved by including all CFTR2‐causing mutations in the Israeli panel. Conclusions Our data reveal an overwhelming hidden abundance of CFTR gene mutations suggesting that expanded preconception carrier screening might achieve higher preconception detection rates.
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Affiliation(s)
- Doron M Behar
- Clalit National Personalized Medicine ProgramDepartment of Community Medicine and EpidemiologyCarmel Medical CenterHaifaIsrael.,Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Gene by GeneGenomic Research CenterHoustonTexas
| | - Ori Inbar
- The Cystic Fibrosis Foundation of IsraelRamat GanIsrael
| | - Michal Shteinberg
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pulmonology Institute and CF CenterCarmel Medical CenterHaifaIsrael
| | - Michal Gur
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pediatric Pulmonary Institute and CF CenterRappaport Children's HospitalRambam Health Care CampusHaifaIsrael
| | - Huda Mussaffi
- Kathy and Lee Graub Cystic Fibrosis CenterSchneider Children's Medical Center of IsraelPetach TikvaIsrael.,Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
| | - David Shoseyov
- Cystic Fibrosis CenterHadassah-Hebrew University Medical CenterJerusalemIsrael
| | | | | | | | - Fahed Hakim
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pediatric Pulmonary Institute and CF CenterRappaport Children's HospitalRambam Health Care CampusHaifaIsrael
| | - Meir Mei-Zahav
- Kathy and Lee Graub Cystic Fibrosis CenterSchneider Children's Medical Center of IsraelPetach TikvaIsrael.,Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
| | | | - Adi Dagan
- Cystic Fibrosis CenterSheba Medical CenterRamat GanIsrael
| | - Dario Prais
- Kathy and Lee Graub Cystic Fibrosis CenterSchneider Children's Medical Center of IsraelPetach TikvaIsrael.,Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
| | - Ifat Sarouk
- Cystic Fibrosis CenterSheba Medical CenterRamat GanIsrael
| | - Patrick Stafler
- Kathy and Lee Graub Cystic Fibrosis CenterSchneider Children's Medical Center of IsraelPetach TikvaIsrael.,Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
| | | | - Gidon Akler
- Gene by GeneGenomic Research CenterHoustonTexas
| | - Elie Picard
- Cystic Fibrosis CenterShaare Zedek Medical CenterHebrew University Medical CenterJerusalemIsrael
| | - Micha Aviram
- Cystic Fibrosis CenterSoroka Medical CenterBeershevaIsrael
| | - Ori Efrati
- Cystic Fibrosis CenterSheba Medical CenterRamat GanIsrael
| | - Galit Livnat
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pulmonology Institute and CF CenterCarmel Medical CenterHaifaIsrael
| | - Joseph Rivlin
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pulmonology Institute and CF CenterCarmel Medical CenterHaifaIsrael
| | - Lea Bentur
- Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael.,Pediatric Pulmonary Institute and CF CenterRappaport Children's HospitalRambam Health Care CampusHaifaIsrael
| | - Hannah Blau
- Kathy and Lee Graub Cystic Fibrosis CenterSchneider Children's Medical Center of IsraelPetach TikvaIsrael.,Sackler Faculty of MedicineTel Aviv UniversityRamat AvivIsrael
| | - Eitan Kerem
- Cystic Fibrosis CenterHadassah-Hebrew University Medical CenterJerusalemIsrael
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