Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact ...of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment.
Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed.
Significant improvements in FEV
, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03).
Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota.
•CFTR modulation with ivacaftor significantly improves clinical outcomes for PWCF.•Only modest changes in overall microbial community composition are observed following one year of ivacaftor ...treatment.•However, there was a shift towards a bacterial ecology associated with less severe CF lung disease with an increased microbial richness and diversity.•Furthermore, a significant correlation was observed between richness and diversity and lower levels of circulating markers of inflammation.
Treatment with Ivacaftor provides a significant clinical benefit in people with cystic fibrosis (PWCF) with the class III G551D-CFTR mutation. This study determined the effect of CFTR modulation with ivacaftor on the lung microbiota in PWCF.
Using both extended-culture and culture-independent molecular methods, we analysed the lower airway microbiota of 14 PWCF, prior to commencing ivacaftor treatment and at the last available visit within the following year. We determined total bacterial and Pseudomonas aeruginosa densities by both culture and qPCR, assessed ecological parameters and community structure and compared these with biomarkers of inflammation and clinical outcomes.
Significant improvement in FEV1, BMI, sweat chloride and levels of circulating inflammatory biomarkers were observed POST-ivacaftor treatment. Extended-culture demonstrated a higher density of strict anaerobic bacteria (p = 0.024), richness (p = 1.59*10−4) and diversity (p = 0.003) POST-treatment. No significant difference in fold change was observed by qPCR for either total bacterial 16S rRNA copy number or P. aeruginosa density for oprL copy number with treatment. Culture-independent (MiSeq) analysis revealed a significant increase in richness (p = 0.03) and a trend towards increased diversity (p = 0.07). Moreover, improvement in lung function, richness and diversity displayed an inverse correlation with the main markers of inflammation (p < 0.05).
Following treatment with ivacaftor, significant improvements in clinical parameters were seen. Despite modest changes in overall microbial community composition, there was a shift towards a bacterial ecology associated with less severe CF lung disease. Furthermore, a significant correlation was observed between richness and diversity and levels of circulating inflammatory markers.
One of the most common and most severe forms of primary antibody deficiency encountered in the clinical setting is a heterogeneous group of syndromes termed common variable immune deficiency (CVID). ...This disorder is characterized by reduced immunoglobulin production and increased susceptibility to infection, particularly of the respiratory tract. Infection and subsequent immunological/inflammatory processes may contribute to the development of pulmonary complications such as bronchiectasis and interstitial lung disease. Immunoglobulin replacement and/or antibiotic therapy, to prevent infection, are routinely prescribed treatments. However, chronic lung disease, the major cause of morbidity and mortality in this patient cohort, may still progress. This clinical progression suggests that pathogens recalcitrant to currently prescribed treatments and other immunological defects may be contributing to the development of pulmonary disease. This review describes the potential role of microbiological and non-B cell immunological factors, including T-cells, neutrophils, complement, toll like receptors, and antimicrobial peptides, in the pathogenicity of chronic lung disease in patients with CVID.
CORK Study in Cystic Fibrosis Ronan, Nicola J.; Einarsson, Gisli G.; Twomey, Maria ...
Chest,
February 2018, 2018-02-00, Letnik:
153, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact ...of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment.
Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed.
Significant improvements in FEV1, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03).
Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota.
This research was designed to broaden current elementary science reform efforts by including the voices of our young scientists. Ten high school students who were defined as possessing both coherent ...science knowledge and scientific habits of mind were selected for the study. Through a three-part series of in-depth, phenomenological interviews, these students revealed early childhood experiences from birth through age ten to which they attributed their development of science knowledge and scientific habits of mind. Educational connoisseurship and criticism provided the framework through which the experiences were analyzed. The research revealed the overwhelming role of scientific habits of mind in the current success of these young scientists. Scientific habits of mind were developed through the structures and relationships in the home. Parents of the participants provided a non-authoritarian, fun, playful, tolerant atmosphere in which messes and experimentation were the norm. Large blocks of uninterrupted, unstructured time and space that "belonged" to the child allowed these children to follow where curiosity led. Frequently, the parent modeled scientific habits of mind. Good discipline in the minds of these families had nothing to do with punishments, rewards, or rules. The parents gave the children responsibilities, "free rein," and their trust, and the children blossomed in that trust and mutual respect. Parents recognized and supported the uniqueness, autonomy, interests, and emotions of the child. Above all, the young scientists valued the time, freedom, patience, and emotional support provided by their parents. For girls, construction toys, hot wheels, sand boxes, and outdoor experiences were particularly important. Art classes, free access to art media, sewing, music, and physical activity facilitated observational skills and spatial relationship development. The girls knew that doing traditionally masculine and feminine activities were acceptable and celebrated by both parents. The time has come to include scientific habits of mind in science education reform. The time has come for science education reform to espouse fun and playfulness, large blocks of unstructured time, responsibility and trust, emotional support, and caring teacher-child relationships. The time has come to listen to the voices of our young scientists.
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