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Cystic Fibrosis: Causes, Diagnosis, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 June 2022) | Viewed by 5412

Special Issue Editor


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Guest Editor
Queens medical research institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
Interests: cystic fibrosis; lung disease; respiratory diseases

Special Issue Information

Dear Colleagues, 

Cystic fibrosis (CF) is a common monogenic disorder associated with destructive lung disease and recurrent pulmonary infections.  Until recently, the only potentially curative treatment was lung transplantation, however, the advent of new therapies such as cystic fibrosis transmembrane conductance regulator (CFTR) modulators have led to major changes in the way we treat CF, and will potentially change the outcome for at least 90% of people with CF. In this issue of the journal, we will cover three main aspects of CF. (1) The genetic causes of CF, and how the genotype may have a direct bearing on prognosis, even from birth. We will address diagnosis both in terms of newborn screening, but also the challenges of diagnosis in later life and the contribution of CFTR-related disorders to the landscape of CF treatment. (2) We will also explore the use of biomarkers in stratifying risk for patients, response to novel therapies and the diagnosis of pulmonary exacerbation in this section. (3) We will explore the treatment options for patients in the era of highly effective CFTR modulators and how standard CF therapies may be integrated with these new treatments. We will also look to the future of CF care, including strategies to repair damaged lungs in people with CF and gene-editing therapies, to address the lack of therapeutics for people with CF who have mutation combinations not amenable to CFTR modulation. Finally, we will address how the landscape may change in CF and how we manage the disease, including multi-disciplinary treatment over the course of one’s life, and how the pulmonary exacerbation may change from being a frequent feature of CF to a less frequent but clinically significant complication for people with CF.

Dr. Robert D. Gray
Guest Editor

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Keywords

  • cystic fibrosis
  • cystic fibrosis transmembrane conductance regulator
  • lung disease
  • pulmonary infections

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Published Papers (2 papers)

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Research

11 pages, 1724 KiB  
Article
Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients
by Anna Engell Holm, Hans Henrik Lawaetz Schultz, Helle Krogh Johansen, Tania Pressler, Thomas Kromann Lund, Martin Iversen and Michael Perch
J. Clin. Med. 2021, 10(6), 1275; https://doi.org/10.3390/jcm10061275 - 19 Mar 2021
Cited by 21 | Viewed by 2410
Abstract
Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization [...] Read more.
Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization after transplantation have been described, but the impact on survival after stratification of bacteria is not well elucidated. We did a single-center retrospective analysis of 99 consecutive CF patients who underwent lung transplantation since the beginning of the Copenhagen Lung Transplant program in 1992 until October 2014. Two patients were excluded due to re-transplantation. From the time of CF diagnosis, patients had monthly sputum cultures. After transplantation, CF-patients had bronchoscopy with bronchoalveolar lavage at 2, 4, 6 and 12 weeks and 6, 12, 18 and 24 months after transplantation, as well as sputum samples if relevant. Selected culture results prior to and after transplantation were stored. We focused on colonization with the most frequent bacteria: Pseudomonas aeruginosa (PA), Stenotrophomonas maltophilia (SM), Achromobacter xylosoxidans (AX) and Burkholderia cepacia complex (BCC). Pulsed-field gel electrophoresis (PFGE) was used to identify clonality of bacterial isolates obtained before and after lung transplantation. Time to re-colonization was defined as the time from transplantation to the first positive culture with the same species. Seventy-three out of 97 (75%) had sufficient culture data for analyses with a median of 7 (1–91) cultures available before and after transplantation. Median colonization-free survival time was 23 days until the first positive culture after transplantation. After 2 years, 59 patients (81%) were re-colonized, 33 (48.5%) with PA, 7 (10.3%) with SM, 12 (17.6%) with AX, and 7 (10.3%) with BCC. No difference in survival was observed between the patients colonized within the first 2 years and those not colonized. Re-colonization of bacteria in the lower airways occurred at a median of 23 days after transplantation in our cohort. In our patient cohort, survival was not influenced by re-colonization or bacterial species. Full article
(This article belongs to the Special Issue Cystic Fibrosis: Causes, Diagnosis, and Treatment)
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11 pages, 1524 KiB  
Article
Leukocyte Telomere Length Is Not Reduced in Children and Adults with Cystic Fibrosis but Associates with Clinical Characteristics—A Cross-Sectional Study
by Aleksandra Glapa-Nowak, Shivaprakash Jagalur Mutt, Aleksandra Lisowska, Ewa Sapiejka, Joanna Goździk-Spychalska, Mirosława Wieczorek-Filipiak, Sławomira Drzymała-Czyż, Jan Krzysztof Nowak, Olaf Thalmann, Karl-Heinz Herzig and Jarosław Walkowiak
J. Clin. Med. 2021, 10(4), 590; https://doi.org/10.3390/jcm10040590 - 4 Feb 2021
Cited by 2 | Viewed by 1792
Abstract
We hypothezied that telomere length is considerably altered in cystic fibrosis (CF) patients compared to healthy subjects (HS), and that leukocyte telomere length variation reflects the severity of CF. Relative telomere length (RTL) was assessed by qPCR in 70 children aged 5–10 (34 [...] Read more.
We hypothezied that telomere length is considerably altered in cystic fibrosis (CF) patients compared to healthy subjects (HS), and that leukocyte telomere length variation reflects the severity of CF. Relative telomere length (RTL) was assessed by qPCR in 70 children aged 5–10 (34 CF; 36 HS) and 114 adults aged 18–45 (53 CF; 61 HS). Telomere length was similar in CF and HS (median (interquartile range): 0.799 (0.686–0.950) vs. 0.831 (0.707–0.986); p = 0.5283) both in children and adults. In adults, women had longer telomeres than men (0.805 (0.715–0.931) vs. 0.703 (0.574–0.790); p = 0.0002). Patients treated with inhaled corticosteroids had a shorter RTL compared to those without steroid therapy (0.765 (0.664–0.910) vs. 0.943 (0.813–1.191); p = 0.0007) and this finding remained significant after adjusting for gender, age, BMI, and child/adult status (p = 0.0003). Shorter telomeres were independently associated with the presence of comorbidities (0.763 (0.643–0.905) vs. 0.950 (0.783–1.130); p = 0.0006) and antibiotic treatment at the moment of blood sampling (0.762 (0.648–0.908) vs. 0.832 (0.748–1.129); p = 0.0172). RTL correlated with number of multiple-day hospitalizations (rho = −0.251; p = 0.0239), as well as number of hospitalization days (rho = −0.279; p = 0.0113). Leukocyte RTL in children and adults with CF was not shorter than in healthy controls, and did not seem to have any potential as a predictor of CF survival. However, it inversely associated with the investigated clinical characteristics. Full article
(This article belongs to the Special Issue Cystic Fibrosis: Causes, Diagnosis, and Treatment)
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