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Sadras I, Kerem E, Livnat G, Sarouk I, Breuer O, Reiter J, Gileles-Hillel A, Inbar O, Cohen M, Gamliel A, Stanleigh N, Gunawardena T, Bartlett C, Gonska T, Moraes T, Eckford PDW, Bear CE, Ratjen F, Kerem B, Wilschanski M, Shteinberg M, Cohen-Cymberknoh M. Clinical and functional efficacy of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis carrying the N1303K mutation. J Cyst Fibros 2023; 22:1062-1069. [PMID: 37331863 DOI: 10.1016/j.jcf.2023.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) significantly improves health outcomes in people with cystic fibrosis (pwCF) carrying one or two F508del mutations. According to in vitro assays performed in FRT cells, 178 additional mutations respond to ELX/TEZ/IVA. The N1303K mutation is not included in this list of mutations. Recent in vitro data suggested that ELX/TEZ/IVA increases N1303K-CFTR activity. Based on the in vitro response, eight patients commenced treatment with ELX/TEZ/IVA. METHODS Two homozygotes; and six compound heterozygotes N1303K/nonsense or frameshift mutation pwCF were treated off label with ELX/TEZ/IVA. Clinical data before and 8 weeks after starting treatment were prospectively collected. The response to ELX/TEZ/IVA was assessed in intestinal organoids derived from 5 study patients and an additional patient carrying N1303K that is not receiving treatment. RESULTS Compared to the values before commencing treatment, mean forced expiratory volume in 1 second increased by 18.4 percentage points and 26.5% relative to baseline, mean BMI increased by 0.79 Kg/m2, and mean lung clearance index decreased by 3.6 points and 22.2%. There was no significant change in sweat chloride. Nasal potential difference normalized in four patients and remained abnormal in three. Results in 3D intestinal organoids and 2D nasal epithelial cultures showed a response in CFTR channel activity. CONCLUSIONS This report supports the previously reported in vitro data, performed in human nasal and bronchial epithelial cells and intestinal organoids, that pwCF who carry the N1303K mutation have a significant clinical benefit by ELX/TEZ/IVA treatment.
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Affiliation(s)
- Ido Sadras
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Eitan Kerem
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel.
| | - Galit Livnat
- Cystic Fibrosis Center, Carmel Medical center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Israel
| | - Ifat Sarouk
- Pediatric Pulmonology Unit, The National Center for Cystic Fibrosis, Sheba Medical Center, Tel Hashomer and the Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Israel
| | - Oded Breuer
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Joel Reiter
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Alex Gileles-Hillel
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Ori Inbar
- The Cystic Fibrosis Foundation of Israel, Israel
| | - Michael Cohen
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Ayelet Gamliel
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Noemie Stanleigh
- Department of Genetics, The Life Sciences Institute, Hebrew University, Jerusalem Israel
| | - Tarini Gunawardena
- Molecular Medicine, Hospital for Sick Children, Toronto, ON, Canada; Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Claire Bartlett
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Tanja Gonska
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada; Division of Gastroenterology, Hepatology & Nutrition, Division of Respiratory Medicine, SickKids Hospital, Toronto, ON, Canada; Department of Physiology and Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Theo Moraes
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada; Division of Gastroenterology, Hepatology & Nutrition, Division of Respiratory Medicine, SickKids Hospital, Toronto, ON, Canada; Department of Physiology and Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Paul D W Eckford
- Molecular Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Christine E Bear
- Molecular Medicine, Hospital for Sick Children, Toronto, ON, Canada; Department of Physiology and Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Felix Ratjen
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada; Division of Gastroenterology, Hepatology & Nutrition, Division of Respiratory Medicine, SickKids Hospital, Toronto, ON, Canada; Department of Physiology and Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Batsheva Kerem
- Department of Genetics, The Life Sciences Institute, Hebrew University, Jerusalem Israel
| | - Michael Wilschanski
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Michal Shteinberg
- Cystic Fibrosis Center, Carmel Medical center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Israel
| | - Malena Cohen-Cymberknoh
- Cystic Fibrosis Center, Hadassah Hebrew Medical Center and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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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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Ramalho AS, Fürstová E, Vonk AM, Ferrante M, Verfaillie C, Dupont L, Boon M, Proesmans M, Beekman JM, Sarouk I, Vazquez Cordero C, Vermeulen F, De Boeck K. Correction of CFTR function in intestinal organoids to guide treatment of cystic fibrosis. Eur Respir J 2021; 57:13993003.02426-2019. [PMID: 32747394 DOI: 10.1183/13993003.02426-2019] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/29/2020] [Indexed: 11/05/2022]
Abstract
RATIONALE Given the vast number of cystic fibrosis transmembrane conductance regulator (CFTR) mutations, biomarkers predicting benefit from CFTR modulator therapies are needed for subjects with cystic fibrosis (CF). OBJECTIVES To study CFTR function in organoids of subjects with common and rare CFTR mutations and evaluate correlations between CFTR function and clinical data. METHODS Intestinal organoids were grown from rectal biopsies in a cohort of 97 subjects with CF. Residual CFTR function was measured by quantifying organoid swelling induced by forskolin and response to modulators by quantifying organoid swelling induced by CFTR correctors, potentiator and their combination. Organoid data were correlated with clinical data from the literature. RESULTS Across 28 genotypes, residual CFTR function correlated (r2=0.87) with sweat chloride values. When studying the same genotypes, CFTR function rescue by CFTR modulators in organoids correlated tightly with mean improvement in lung function (r2=0.90) and sweat chloride (r2=0.95) reported in clinical trials. We identified candidate genotypes for modulator therapy, such as E92K, Q237E, R334W and L159S. Based on organoid results, two subjects started modulator treatment: one homozygous for complex allele Q359K_T360K, and the second with mutation E60K. Both subjects had major clinical benefit. CONCLUSIONS Measurements of residual CFTR function and rescue of function by CFTR modulators in intestinal organoids correlate closely with clinical data. Our results for reference genotypes concur with previous results. CFTR function measured in organoids can be used to guide precision medicine in patients with CF, positioning organoids as a potential in vitro model to bring treatment to patients carrying rare CFTR mutations.
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Affiliation(s)
- Anabela S Ramalho
- Dept of Development and Regeneration, Woman and Child Unit, CF Research Lab, KU Leuven, Leuven, Belgium
| | - Eva Fürstová
- Dept of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Annelotte M Vonk
- Dept of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.,Regenerative Medicine Center, University Medical Centre, Utrecht, The Netherlands
| | - Marc Ferrante
- Dept of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Dept of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Catherine Verfaillie
- Dept of Development and Regeneration, Stem Cell Biology and Embryology, KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Dept of Chronic Diseases, Metabolism and Ageing; Pneumology, KU Leuven, Leuven, Belgium.,Dept of Respiratory Diseases, University Hospital of Leuven, Leuven, Belgium
| | - Mieke Boon
- Dept of Development and Regeneration, Woman and Child Unit, CF Research Lab, KU Leuven, Leuven, Belgium.,Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Marijke Proesmans
- Dept of Development and Regeneration, Woman and Child Unit, CF Research Lab, KU Leuven, Leuven, Belgium.,Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Jeffrey M Beekman
- Dept of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.,Regenerative Medicine Center, University Medical Centre, Utrecht, The Netherlands
| | - Ifat Sarouk
- Pulmonology Pediatrics and National CF Center Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Francois Vermeulen
- Dept of Development and Regeneration, Woman and Child Unit, CF Research Lab, KU Leuven, Leuven, Belgium.,Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Kris De Boeck
- Dept of Development and Regeneration, Woman and Child Unit, CF Research Lab, KU Leuven, Leuven, Belgium.,Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
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Vilozni D, Dagan A, Sarouk I, Bar-Aluma BE, Ashkenazi M, Bezalel Y, Efrati O. Advanced Lung Disease in Patients with Cystic Fibrosis Is Associated with Low Diffusion capacity. Isr Med Assoc J 2020; 22:770-774. [PMID: 33381950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The single-breath diffusing capacity of the lungs (DLCOSB) test measures the extent to which carbon monoxide (CO) passes from the lung air sacs into the blood. The accessible alveolar volume (VASB) is measured by inert gas during a 10-second period. The single-breath transfer coefficient of the lung for carbon monoxide (KCOSB) is the DLCOSB divided by VASB. Cystic fibrosis (CF) disease comprises progressive airway obstruction with bronchiectasis and parenchyma fibrosis. Yet, the KCOSB appears insignificant in the assessment of pulmonary function in CF. OBJECTIVES To challenge the precision of normal KCOSB in CF. METHODS The authors collected pulmonary function tests (PFT) data from 74 confirmed CF patients (mean age 26 ± 10 years) with various levels of pulmonary disease severity. Tests included spirometry, DLCOBP, and body plethysmography (BP). Anatomical dead space was calculated by deducting anatomical dead space from total lung capacity TLC(BP) to establish alveolar volume (VABP) and to determine KCOBP. We also included individual data of arterial pCO2 blood-gas level. RESULTS KCOSB values were normal or higher in most patients, regardless of patient FEV1 value (R2 = 0.2204; P < 0.02). In contrast, the measurements of KCOBP were low corresponding with low FEV1 values, and negatively correlated with the elevation of trapped air and pCO2 levels (R2 = 0.1383; P = 0.0133, P > 0.05, respectively). CONCLUSIONS The 10- second perfusion time of the inert gas during DLCOSB represent the communicative alveolar volume in CF patients with advanced pulmonary disease. The findings justify the use of DLCOSB with the deterioration of FEV1 and elevation of pCO2 levels.
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Affiliation(s)
- Daphna Vilozni
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Dagan
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sarouk
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bat-El Bar-Aluma
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Ashkenazi
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Bezalel
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Efrati
- Department of Pediatric Pulmonology, the National Center for Cystic Fibrosis, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, associated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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El Bar Aluma B, Sarouk I, Senderowitz H, Cohen-Cymberknoh M, Khazanov N, Dagan A, Bezalel Y, Ashkenazi M, Keler S, Efrati O. Phenotypic and molecular characteristics of CF patients carrying the I1234V mutation. Respir Med 2020; 170:106027. [DOI: 10.1016/j.rmed.2020.106027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
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Barak S, Anikster Y, Sarouk I, Stern E, Eisenstein E, Yissar T, Sherr-Lurie N, Raas-Rothschild A, Guttman D. Correction: Barak, S. et al. “Long-Term Outcomes of Early Enzyme Replacement Therapy for Mucopolysaccharidosis IV: Clinical Case Studies of Two Siblings”. Diagnostics 2020, 10, 108. Diagnostics (Basel) 2020; 10:diagnostics10070480. [PMID: 32674526 PMCID: PMC7400141 DOI: 10.3390/diagnostics10070480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sharon Barak
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan 5265601, Israel; (E.E.); (T.Y.); (D.G.)
- Kaye Academic College of Education, M.Ed. Programs, Beer-Sheva 8414201, Israel
- Correspondence:
| | - Yair Anikster
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
- Wohl Institute for Translational Medicine, Chaim Sheba Medical Center, Ramat Gan 5265601, Israel
| | - Ifat Sarouk
- The National AT Center, Chaim Sheba Medical Center, Ramat Gan 5265601, Israel;
- The Pediatric Pulmonology Unit, Chaim Sheba Medical Center, Edmond and Lilly Safra Children Hospital, Tel HaShomer, Ramat Gan 5265601, Israel
| | - Eve Stern
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children’s Hospital, Ramat-Gan 5265601, Israel;
| | - Etzyona Eisenstein
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan 5265601, Israel; (E.E.); (T.Y.); (D.G.)
| | - Tamar Yissar
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan 5265601, Israel; (E.E.); (T.Y.); (D.G.)
| | - Nir Sherr-Lurie
- Pediatric Orthopedic Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Ramat Gan 5265601, Israel;
| | - Annick Raas-Rothschild
- Institute of Rare Diseases, Edmond and Lily Safra Children’s hospital, Chaim Sheba Medical Center, Ramat Gan 5265601, Israel;
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv postcode Israel, Ramat Aviv 69978, Israel
| | - Dafna Guttman
- Department of Pediatric Rehabilitation, Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan 5265601, Israel; (E.E.); (T.Y.); (D.G.)
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Ramalho AS, Cuyx S, Boon M, Dupont L, Proesmans M, Sarouk I, Cordero C, Vermeulen F, De Boeck K. WS11.1 Response to CFTR modulators in organoids from patients with cystic fibrosis as a tool to select candidates to treatment. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shenhod E, Benzeev B, Sarouk I, Heimer G, Nissenkorn A. Functional parameter measurements in children with ataxia telangiectasia. Dev Med Child Neurol 2020; 62:207-213. [PMID: 31468510 DOI: 10.1111/dmcn.14334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
AIM To collect preliminary functional data on ataxia telangiectasia and create a disease specific scale: the Ataxia Telangiectasia Functional Scale (ATFS). METHOD Retrospective information on patients with ataxia telangiectasia referred to the Assistive Technology Unit was included. Functional mobility scales (the Gross Motor Function Classification System [GMFCS] and the Functional Mobility Scale [FMS]-5, FMS-50, FMS-500) and activities of daily living [ADL] parameters were recorded. We created a 51-point ATFS, that consisted of three ambulation items adapted for ataxia telangiectasia in the frame of FMS (home, school, outdoors), five ADL items, and one schooling item. RESULTS Twenty-seven participants (17 males, 10 females; mean age 10y 8mo [SD 5y 1mo], range 1y 9mo-25y 6mo), were enrolled; 168 measurements were recorded. Patients walked at a mean age of 1 year 4 months (SD 5y 4mo) and lost ambulatory capacity at 8 years 8 months (SD 2y 1mo). GMFCS level and FMS-5, FMS-50, FMS-500 assessments correlated with age (Spearman's correlations r=0.555, -0.617, -0.639, -0.662 respectively, p<0.01 for all), but plateaued after 12 years of age. ATFS mean score was 37.46 (SD 7.88) and increased with age (Spearman's correlation r=0.585, p<0.01). The scale showed three stages of disease progression. INTERPRETATION In this pilot study we show longitudinal functional data of ambulation and ADL skills in ataxia telangiectasia, and created a framework for a functional scale. This functional scale closely approximated disease course, but further validation is required. WHAT THIS PAPER ADDS The Gross Motor Function Classification System and the Functional Mobility Scale are ill-suited for ataxia telangiectasia assessments. Three functional mobility scales (home, school, outdoors) suited to ataxia telangiectasia were created. The Ataxia Telangiectasia Functional Scale (ATFS) combines mobility and items of activities of daily living. The ATFS closely approximates the three-stage progression of the disorder.
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Affiliation(s)
- Efrat Shenhod
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruria Benzeev
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sarouk
- The National AT Center, Chaim Sheba Medical Center, Tel HaShomer, Israel.,The Pediatric Pulmonology Unit, Chaim Sheba Medical Center, Edmond and Lilly Safra Children Hospital, Tel HaShomer, Israel
| | - Gali Heimer
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | - Andreea Nissenkorn
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Neurology Unit, Sheba Medical Center, Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel.,The Service for Rare Disorders, Chaim Sheba Medical Center, Edmond and Lilly Safra Children Hospital, Tel HaShomer, Israel
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9
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Ashkenazi M, Nathan N, Sarouk I, Aluma BEB, Dagan A, Bezalel Y, Keler S, Vilozni D, Efrati O. Nutritional Status in Childhood as a Prognostic Factor in Patients with Cystic Fibrosis. Lung 2019; 197:371-376. [DOI: 10.1007/s00408-019-00218-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/12/2019] [Indexed: 01/01/2023]
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Nissenkorn A, Erlich T, Zilberman DE, Sarouk I, Krauthammer A, Kitrey ND, Heimer G, BenZeev B, Mor Y. Secondary enuresis and urological manifestations in children with ataxia telangiectasia. Eur J Paediatr Neurol 2018; 22:1118-1123. [PMID: 30100180 DOI: 10.1016/j.ejpn.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ataxia telangiectasia (AT) is a neurodegenerative cerebellar disorder, caused by mutations in the ATM gene, involved in DNA repair. Radiosensitivity, progressive ataxia, immune deficiency and malignancies, are well known symptoms, but urological manifestations are scarcely described. OBJECTIVE To characterize urologic manifestations in a large cohort of AT patients. METHODS Retrospective cross-sectional chart study comprising 52 AT patients followed at a National AT Center. RESULTS 25% of the cohort (13 patients/8 males) had urologic symptoms, which presented at 11 ± 4.3 years. The most common symptom was secondary enuresis affecting 15% of the patients (8 children/4 males). Incontinence appeared at 8 ± 6.2 years of age, and resolved spontaneously within 15 ± 8.3 months in 6 patients. It preceded loss of ambulatory capacity by 1-2 years in 7 patients. Lumbosacral MRI were normal (4 children) and urine cultures (all) were negative. Urodynamic evaluation that was performed in only one patient revealed overactive bladder. Additional manifestations were macroscopic hematuria due to bladder telangiectasia in a 12-year-old, and renal cell carcinoma in a 22-year-old. Other manifestations unrelated to AT were neprolithiasis, vesico-ureteral reflux and scrotal pain, each in 1 patient. DISCUSSION Transient secondary enuresis is a frequent finding in AT patients, heralding loss of ambulatory capacity, tough it's pathophysiological mechanism is largely no understood.
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Affiliation(s)
- Andreea Nissenkorn
- Service for Rare Disorders, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Tomer Erlich
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ifat Sarouk
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; National AT Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Pediatric Pulmonology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Alexander Krauthammer
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam D Kitrey
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Gali Heimer
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bruria BenZeev
- Pediatric Neurology Unit, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Mor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Service of Pediatric Urology, Edmond and Lilly Safra Children Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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11
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Vilozni D, Dagan A, Lavie M, Sarouk I, Bar-Aluma BE, Ashkenazi M, Mendelovich SL, Betzalel Y, Efrati O. The Value of Measuring Inspiratory Capacity in Subjects With Cystic Fibrosis. Respir Care 2018; 63:981-987. [DOI: 10.4187/respcare.05920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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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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13
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Krauthammer A, Lahad A, Goldberg L, Sarouk I, Weiss B, Somech R, Soudack M, Pessach IM. Elevated IgM levels as a marker for a unique phenotype in patients with Ataxia telangiectasia. BMC Pediatr 2018; 18:185. [PMID: 29866155 PMCID: PMC5987459 DOI: 10.1186/s12887-018-1156-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 05/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Ataxia telangiectasia (AT) is a rare, multi-systemic, genetic disorder. Mutations in the ATM gene cause dysfunction in cell-cycle, apoptosis and V (D) J recombination leading to neurodegeneration, cellular, humoral immunodeficiencies and predisposition to malignancies. Previous studies have suggested that a sub-group of AT patients with elevated IgM levels have a distinct and more severe phenotype. In the current study we aimed to better characterize this group of patients. METHODS We performed a retrospective review of 46 patient records, followed from January 1986 to January 2015 at the Israeli National AT Center. Demographic, clinical, radiological, laboratory data was reviewed and compared between AT patients with elevated IgM levels (EIgM) and patients with normal IgM levels (NIgM). RESULTS 15/46(32.6%) patients had significantly elevated IgM levels. This group had a unique phenotype characterized mainly by increased risk of infection and early mortality. Colonization of lower respiratory tract with Mycobacterium gordonae and Pseudomonas aeruginosa as well as viral skin infections were more frequent in EIgM patients. Patients with NIgM had a significantly longer survival as compared to patients with EIgM but had an increased incidence of fatty liver or cirrhosis. T-cell recombination excision circles and kappa-deleting element recombination circle levels were significantly lower in the EIgM group, suggesting an abnormal class switching in this group. CONCLUSIONS EIgM in AT patients are indicative of a more severe phenotype that probably results from a specific immune dysfunction. EIgM in AT should be considered a unique AT phenotype that may require different management.
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Affiliation(s)
- Alexander Krauthammer
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avishay Lahad
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Pediatric Gastroenterology Unit, The Edmond and Lily Safra Children’s Hospital, Tel- Hashomer, Israel
| | - Lior Goldberg
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ifat Sarouk
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children’s Hospital, Tel- Hashomer, Israel
| | - Batia Weiss
- Pediatric Gastroenterology Unit, The Edmond and Lily Safra Children’s Hospital, Tel- Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raz Somech
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michalle Soudack
- Department of Pediatrics, The Edmond and Lily Safra Children’s Hospital, 52625 Tel- Hashomer, Israel
- Pediatric Radiology Unit, The Edmond and Lily Safra Children’s Hospital, Tel- Hashomer, Israel
| | - Itai M. Pessach
- The Claudio Cohen Department of Pediatric Intensive Care, The Edmond and Lily Safra Children’s Hospital, Tel- Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Dagan A, Cohen-Cymberknoh M, Shteinberg M, Levine H, Vilozni D, Bezalel Y, Bar Aluma BE, Sarouk I, Ashkenazi M, Lavie M, Tsabari R, Blau H, Kerem E, Bentur L, Efrati O, Livnat G. Ivacaftor for the p.Ser549Arg (S549R) gating mutation - The Israeli experience. Respir Med 2017; 131:225-228. [PMID: 28947035 DOI: 10.1016/j.rmed.2017.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Received: 06/22/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ivacaftor is a drug that increases the probability of the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel remaining open. Information about the efficacy of ivacaftor in patients carrying the rare p.Ser549Arg (S549R) CFTR mutation is sparse. AIM Efficacy of ivacaftor treatment in patients carrying the p.Ser549Arg (S549R) CFTR mutation. METHODS Data obtained from CF patients receiving ivacaftor for one year. RESULTS Eight CF patients, mean age 21 ± 10 years, received ivacaftor. After one year, significant improvement was found in FEV1, increasing from 74% to 88% (p < 0.001), FVC, 89% to 101% (p = 0.019), and FEF25-75, 59%-76% (p = 0.019). Sweat chloride concentration decreased from 116 ± 8 mmol/L to 51 ± 17 mmol/L (p < 0.001), and BMI increased from 20 ± 3 to 22 ± 4 (p = 0.003). Glucose tolerance improved in five patients. There was no significant change in bacterial colonization. CONCLUSIONS Ivacaftor therapy resulted in significant clinical improvement in patients carrying the p.Ser549Arg (S549R) CFTR mutation.
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Affiliation(s)
- Adi Dagan
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel.
| | | | - Michal Shteinberg
- Cystic Fibrosis Center, Carmel Hospital, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - Hagit Levine
- Graub Cystic Fibrosis Center, Schneider Children's Medical Center, Petach Tikva, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Yael Bezalel
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Bat-El Bar Aluma
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Moshe Ashkenazi
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Moran Lavie
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Reuven Tsabari
- Cystic Fibrosis Center, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Hannah Blau
- Graub Cystic Fibrosis Center, Schneider Children's Medical Center, Petach Tikva, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eitan Kerem
- Cystic Fibrosis Center, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Lea Bentur
- Cystic Fibrosis Center, Rambam Health Care Campus, Haifa, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Affiliated with Sackler Medical School, Tel Aviv University, Israel
| | - Galit Livnat
- Cystic Fibrosis Center, Carmel Hospital, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
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15
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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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16
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Shteinberg M, Lulu AB, Blumenfeld Z, Gur M, Bentur L, Mussaffi H, Blau H, Sarouk I, Efrati O, Cohen-Cymberknoh M, Kerem E, Aviram M, Pickard E, Livnat G. 223 Infertility among women with cystic fibrosis: prevalence and risk factors. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30462-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Lavie M, Fisher D, Vilozni D, Forschmidt R, Sarouk I, Kanety H, Hemi R, Efrati O, Modan-Moses D. Glucose intolerance in cystic fibrosis as a determinant of pulmonary function and clinical status. Diabetes Res Clin Pract 2015; 110:276-84. [PMID: 26508676 DOI: 10.1016/j.diabres.2015.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Received: 03/26/2015] [Revised: 09/27/2015] [Accepted: 10/02/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cystic fibrosis related diabetes (CFRD) is associated with a decrease in pulmonary function and nutritional status. We investigated the clinical significance of impaired glucose tolerance (IGT) in cystic fibrosis (CF) patients. METHODS Fifty-five CF patients (aged 22.8 ± 9.2 years, 29 males, mean FEV1 67.9 ± 22% predicted, mean BMI-SDS -0.23 ± 1.1) underwent a 2-h Oral Glucose Tolerance Test (OGTT) with 30-min interval measurements of glucose and insulin. Additional clinical and laboratory data were obtained from the medical charts. RESULTS Thirty-eight participants (69%) had normal glucose tolerance (NGT), 13 (23.7%) had IGT, and 4 (7.3%) had newly diagnosed CFRD. Compared to patients with NGT, patients with IGT had significantly lower BMI-SDS (-1.1 ± 0.8 vs. 0.1 ± 1.1, p<0.001), mean FEV1 (57 ± 19 vs. 74 ± 21% predicted, p<0.01), and albumin (3.9 ± 0.3 vs. 4.3 ± 0.2g/dl, p=0.004), and higher fibrinogen (376 ± 56 vs. 327 ± 48 g/dl, p=0.02). Patients with IGT had impaired β-cell function, with reduced first phase insulin secretion, a delayed insulin peak, and significantly lower total insulin secretion, HOMA-%B and insulinogenic index. Seven patients had HbA1c in the "diabetic" range (≥6.5%; 47.5 mmol/mol), however, HbA1c was not a sensitive or specific marker of glucose tolerance status. CONCLUSIONS IGT in CF patients is associated with increased inflammation and decreased nutritional status and pulmonary function.
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Affiliation(s)
- Moran Lavie
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1).
| | - Dor Fisher
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Rinat Forschmidt
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Hannah Kanety
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Rina Hemi
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Ori Efrati
- Pediatric Pulmonary Unit and The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
| | - Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel(1)
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18
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Sokol G, Vilozni D, Hakimi R, Lavie M, Sarouk I, Bat-El Bar, Dagan A, Ofek M, Efrati O. The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared With Autogenic Drainage in Subjects With Cystic Fibrosis. Respir Care 2015; 60:1819-25. [PMID: 26374905 DOI: 10.4187/respcare.04008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Forced expiration may assist secretion movement by manipulating airway dynamics in patients with cystic fibrosis (CF). Expiratory resistive breathing via a handheld incentive spirometer has the potential to control the expiratory flow via chosen resistances (1-8 mm) and thereby mobilize secretions and improve lung function. Our objective was to explore the short-term effect of using a resistive-breathing incentive spirometer on lung function in subjects with CF compared with the autogenic drainage technique. METHODS This was a retrospective study. Subjects with CF performed 30-45 min of either the resistive-breathing incentive spirometer (n = 40) or autogenic drainage (n = 32) technique on separate days. The spirometer encourages the patient to exhale as long as possible while maintaining a low lung volume. The autogenic drainage technique includes repetitive inspiratory and expiratory maneuvers at various tidal breathing magnitudes while exhalation is performed in a sighing manner. Spirometry was performed before and 20-30 min after the therapy. RESULTS Use of a resistive-breathing incentive spirometer improved FVC and FEV1 by 5-42% in 26 subjects. The forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%) improved by >20% in 9 (22%) subjects. FVC improved the most in subjects with an FEV1 of 40-60% of predicted. Improvements negatively correlated with baseline percent-of-predicted FVC values provided improvements were above 10% (r(2) = 0.28). Values improved in a single subjects using the autogenic drainage technique. CONCLUSIONS These 2 techniques may allow lower thoracic pressures and assist in the prevention of central airway collapse. The resistive-breathing incentive spirometer is a self-administered simple method that may aid airway clearance and has the potential to improve lung function as measured by FVC, FEV1, and FEF25-75% in patients with CF.
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Affiliation(s)
- Gil Sokol
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Ran Hakimi
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Moran Lavie
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Bat-El Bar
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Adi Dagan
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Miryam Ofek
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Vilozni D, Lavie M, Sarouk I, Levi Y, Alcaneses Ofek MR, Efrati O. Cough ability measurements and recurrent respiratory symptoms in individuals with Ataxia Telangiectasia. J Asthma 2015; 53:37-42. [PMID: 26364772 DOI: 10.3109/02770903.2015.1032304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Ataxia-Telangiectasia (A-T) individuals often present with respiratory muscle weakness, causing recurrent respiratory system infections, asthma-like symptoms, and chronic cough life-threatening events. The cough flow volume maneuver may reveal powerless airflow needed for efficient cough. The study aims to explore cough ability in relation to the flow/volume maneuver. METHODS Data collected retrospectively from clinical charts of 35 A-T patients (age 12.7 ± 4.9 years) included forced expiratory and cough flow/volume maneuvers performed on the same day. Analysis compared among the maneuvers matching indices, numbers of cough-spikes, flow rate decay, and the reference data of similar ages. Adjusted to age, BMI, and number of hospitalizations prior to the tests, values were correlated with the cough indices. RESULTS Cough peak-flow (C-PF) was propagated within 90 ± 20 ms compared with peak expiratory flow (PEF > 200 ms). C-PF measured values were higher than expiratory peak-flow measured values (3.27 ± 1.53 L/s versus 3.02 ± 1.52 L/s, respectively, but C-PF (%predicted) values were significantly lower than expiratory peak-flow (%predicted) (46 ± 15 versus 68 ± 20 %predicted, respectively, p < 0.002). The number of spikes/maneuver was low when compared with reference (2.0 ± 0.8 versus 6-12 spikes) and cough vital-capacity was lower than expiratory vital capacity (0.95 ± 0.43 versus 1.03 ± 0.47; p < 0.01). Inefficient C-PF was more prevalent in patients suffering from recurrent respiratory illness. The length of wheelchair confinement duration mostly influenced the C-VC level. CONCLUSIONS The cough flow-volume curve can be applied as a method to follow cough ability in patients with A-T who showed a significantly reduced cough capacity. Further studies are needed to establish if the findings may aid decisions regarding cough assistance.
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Affiliation(s)
- Daphna Vilozni
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
| | - Moran Lavie
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
| | - Ifat Sarouk
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
| | - Yonit Levi
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
| | - Mary-Rose Alcaneses Ofek
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
| | - Ori Efrati
- a The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel, Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center , Ramat-Gan , Israel
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Dagan A, Keller N, Vilozni D, Ramon-Saraf R, Bar BE, Sarouk I, Ashkenazi M, Lavie M, Efrati O. Nocardia Colonization: A Risk Factor for Lung Deterioration in Cystic Fibrosis Patients? Med Sci Monit 2015; 21:1889-94. [PMID: 26125407 PMCID: PMC4498443 DOI: 10.12659/msm.893643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cystic fibrosis (CF) patients are predisposed to infection and colonization with different microbes. Some cause deterioration of lung functions, while others are colonizers without clear pathogenic effects. Our aim was to understand the effects of Nocardia species in sputum cultures on the course of lung disease in CF patients. Material/Methods A retrospective study analyzing the impact of positive Nocardia spp. in sputum of 19 CF patients over a period of 10 years, comparing them with similar status patients without Nocardia growth. Pulmonary function tests (PFTs) are used as indicators of lung disease severity and decline rate in functions per year is calculated. Results No significant difference in PFTs of CF patients with positive Nocardia in sputum was found in different sub-groups according to number of episodes of growth, background variables, or treatment plans. The yearly decline in PFTs was similar to that recognized in CF patients. The control group patients showed similar background data. However, a small difference was found in the rate of decline of their PFTs, which implies a possibly slower rate of progression of lung disease. Conclusions The prognosis of lung disease in CF patients colonized with Nocardia does not seem to differ based on the persistence of growth on cultures, different treatment plans or risk factors. Apparently, Nocardia does not cause a deterioration of lung functions with time. However, it may show a trend to faster decline in PFTs compared to similar status CF patients without isolation of this microorganism in their sputum.
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Affiliation(s)
- Adi Dagan
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Nathan Keller
- Microbiology Laboratories, Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ariel University, Ramat-Gan, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Reut Ramon-Saraf
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Bat-El Bar
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Moshe Ashkenazi
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Moran Lavie
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
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Vilozni D, Lavie M, Sarouk I, Bar-Aluma BE, Dagan A, Ashkenazi M, Ofek M, Efrati O. FVC deterioration, airway obstruction determination, and life span in Ataxia telangiectasia. Respir Med 2015; 109:890-6. [PMID: 26033643 DOI: 10.1016/j.rmed.2015.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/05/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE Forced vital capacity (FVC) values decrease with progress of the disease in Ataxia telangiectasia (AT). OBJECTIVE To study the effect of this process on airway obstruction determination and life span in AT. METHODS Clinical data and yearly best spirometry maneuvers were collected retrospectively from 37 AT patients (196 spirometry tests) during 5.4 ± 1.8yrs (initial age 4-21 y). Twelve patients were walking (7 of them had recurrent respiratory system infections); 25 subjects were confined to wheelchair, of them 8 patients were towards end-stage lung disease. Spirometry indices included Forced Vital Capacity (FVC), mid-expiratory-flow (FEF25-75), and tidal volume (VT). We calculated FEF25-75/FVC and VT/FVC ratios. RESULTS FVC declined from 67 ± 8 while walking to 19 ± 6 %predicted values. FEF25-75 values that were elevated (116 ± 23 %predicted) while walking, decreased to 69 ± 27 %predicted at end-stage where 7 patients responded to bronchodilators. VT/FVC ratio was 0.25 ± 0.06 while walking, increased to 0.35 once on wheelchairs, and further increased to 0.57 ± 0.19 at end-stage disease. FEF25-75/FVC ratio was 2.54 ± 0.70 above normal (∼1.0) increasing to 4.16 ± 0.75 at end stage. A sharp elevation was seen in FEF25-75/FVC ratio when FEV1 was still ∼45 %predicted and 2-years prior to death. CONCLUSIONS Having a low baseline-FVC (60% predicted) artificially raises FEF25-75 values, so FEF25-75 of "mild obstruction" values may indicate severe airway obstruction in AT subjects. VT/FVC and FEF25-75/FVC ratios may therefore assist in revealing higher than normal breathing effort. The results further suggest adding VT/FVC and FEF25-75/FVC ratios to pulmonary function assessments in patients with AT.
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Affiliation(s)
- Daphna Vilozni
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| | - Moran Lavie
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ifat Sarouk
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Bat-El Bar-Aluma
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Adi Dagan
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Moshe Ashkenazi
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Miryam Ofek
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ori Efrati
- The Pediatric Pulmonary Unit and the Ataxia Telangiectasia National Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Lavie M, Manovitz T, Vilozni D, Levy-Mendelovich S, Sarouk I, Weintraubv I, Shoseyov D, Cohen-Cymberknoh M, Rivlin J, Efrati O. Long-term follow-up of distal intestinal obstruction syndrome in cystic fibrosis. World J Gastroenterol 2015; 21:318-325. [PMID: 25574107 PMCID: PMC4284351 DOI: 10.3748/wjg.v21.i1.318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/27/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the long-term follow-up of distal intestinal obstruction syndrome (DIOS) in Israeli cystic fibrosis (CF) patients.
METHODS: This is a multi-center, comparative, retrospective study in which we reviewed the medical records of all CF patients from three major CF centers in Israel who were treated in the period from 1980 to 2012. Patients diagnosed with DIOS were defined as the study group. The patients were diagnosed with DIOS based on their clinical presentation and typical findings on either abdominal X-ray or computerized tomography scan. For the control group, CF patients with no DIOS were matched to the patients in the study group for age, sex, and cystic fibrosis transmembrane conductance regulator (CFTR) mutations. For both groups, the collected data included age, sex, CFTR genotype, weight, height, and body mass index. Clinical data included respiratory function tests in the last five years prior to the study, respiratory function test immediately before and after the DIOS event, number of hospitalizations, sputum culture results, and CF-related conditions diagnosed according to the CF clinical practice guidelines. In the study group, data on the DIOS treatment and tendency for DIOS recurrence were also analyzed.
RESULTS: The medical charts for a total of 350 CF patients were reviewed. Of the 350 CF patients, 26 (7.4%) were diagnosed with DIOS. The control group included 31 CF patients with no DIOS diagnosis. The mean follow-up period was 21.6 ± 8.2 years. The total of DIOS episodes in the follow-up period was 60. The distribution of DIOS episodes was as follows: 6/26 (23.1%) study patients had one episode of DIOS in their lifetime, 7/26 (26.9%) had two episodes, 7/26 (26.9%) had three episodes, and 6/26 (23.1%) had four or more episodes. Compared to the control group, DIOS patients had a significantly higher incidence of meconium ileus in the past (65.4% vs 0%, respectively, P < 0.02), more Aspergillus spp. colonization (34.6% vs 3.2%, respectively, P < 0.02), and a higher number of hospitalizations due to respiratory exacerbations (8.6 vs 6.2 mean total hospitalizations per follow-up period, respectively, P < 0.02). No other significant differences were found between the control and study groups. The conservative treatment of DIOS, which mainly includes hydration and stool softeners, was successful in 82% of the episodes. The survival rate was similar for both groups.
CONCLUSION: CF patients with DIOS suffer from recurrent hospitalizations and airway pathogen acquisition. Although recurrence of DIOS is common, conservative treatment is successful in most patients.
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Lavie M, Shemer O, Sarouk I, Bar Aluma BE, Dagan A, Efrati O, Vilozni D. Several siblings with Cystic Fibrosis as a risk factor for poor outcome. Respir Med 2014; 109:74-8. [PMID: 25528949 DOI: 10.1016/j.rmed.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Received: 06/30/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Occurrence of Cystic Fibrosis (CF) in more than one member in a family is not uncommon. The aim of our study was to assess the influence of multiple siblings with CF on disease expression and outcome. METHODS Study group consisted of 2-siblings (2-sibs, n = 42) or 3/4 siblings (3/4-sibs, n = 22) with CF in one family. Each sibling was matched by age, mutation, and gender to a single CF patient. RESULTS 3/4-sibs subgroup compared to singles showed a lower mean FEV1 with a faster decline rate (58.4 ± 27.5 vs. 72.7 ± 25.4 and -5 ± 6.4 vs. -1.7 ± 2.8 %predicted decline/year respectively, p < .05), more airway colonization by Pseudomonas aeruginosa and Mycobacterium abscessus (15 (68%) vs. 8 (36%) and 7 (32%) vs. 4 (18%), respectively, p < .05) and more lung transplants (5 (23%) vs. 2 (9%), respectively, p < .02). Last mean FEV1 within 3/4-sibs was significantly lower for the youngest sib (p < .05). CONCLUSIONS Three or more CF patients in one family may be a risk factor for more severe disease and poor prognosis. In our view this reflects the burden of disease on the patients and families.
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Affiliation(s)
- Moran Lavie
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel.
| | - Ofer Shemer
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
| | - Bat el Bar Aluma
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
| | - Adi Dagan
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Medical School, Tel-Aviv University, Israel
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Lavie M, Lifshitz I, Vilozni D, Shapira I, Sarouk I, Bar BE, Dagan A, Livnat G, Cohen-Cymberknoh M, Mei-Zahav M, Rivlin J, Efrati O. 297 Arab cystic fibrosis patients in Israel. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Watemberg N, Sarouk I, Fainmesser P. Acute meningitis among infants and toddlers with febrile seizures: time for a reappraisal of the value of a lumbar puncture. Isr Med Assoc J 2012; 14:547-549. [PMID: 23101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Since clinical signs of meningeal irritation in infants may be absent or misleading, the American Academy of Pediatrics in 1996 recommended that a lumbar puncture be performed in young children following a febrile seizure. Recent evidence supports a conservative approach in children who do not look ill at the time of the physician's assessment. Moreover, seizures as the presenting or sole symptom of bacterial meningitis are very rare. OBJECTIVES To assess physicians' compliance with the Academy's recommendations and to determine the incidence of meningitis among febrile seizure patients, including those who did not undergo the puncture. METHODS We conducted a retrospective analysis of the number of punctures obtained in febrile seizure patients aged 6-24 months, focusing on the clinician's indications for performing the procedure and on the clinical course of children who did not undergo the puncture. RESULTS Among 278 patients (84% simple febrile seizure), 52 (18.7%) underwent the procedure. It was performed in 38% of 45 complex febrile seizure cases and in 48% of 91 infants younger than 12 months of age. Aseptic meningitis occurred in two infants, both with post-ictal apathy. Bacterial meningitis was not found and in none of the patients who did not undergo the puncture was meningitis later diagnosed. CONCLUSIONS Compliance with the Academy's recommendations was low, as emergency room physicians based their decision whether to obtain a lumbar puncture solely on clinical grounds. No case of bacterial meningitis was detected among 278 young children with a febrile seizure, including those who did not undergo the puncture.
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Affiliation(s)
- Nathan Watemberg
- Child Neurology Unit, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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