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  1. Article: Lessons from other fields of medicine, Part 2: Cystic fibrosis.

    Vijaykumar, Kadambari / Rowe, Steven M

    Handbook of clinical neurology

    2023  Volume 192, Page(s) 119–130

    Abstract: Cystic fibrosis (CF), first described in 1938, is a common, life-limiting monogenetic disease. The discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989 was crucial in advancing our understanding of disease pathogenesis ...

    Abstract Cystic fibrosis (CF), first described in 1938, is a common, life-limiting monogenetic disease. The discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989 was crucial in advancing our understanding of disease pathogenesis and paving the road for treatment aimed at the fundamental molecular defect. With the delineation of over 2000 variations in the CFTR gene, a sound understanding of the individual variations in cell biology, and electrophysiological abnormalities conferred by the most common defects propelled the advent of targeted disease-modifying therapeutics beginning in 2012. Since then, CF care has transformed beyond just symptomatic treatment to include a variety of small-molecule therapies that address the basic electrophysiologic defect and cause profound improvements in physiology, clinical manifestations, and long-term outcomes, designed to differentially address six genetic/molecular subtypes. This chapter illustrates the progress made toward how fundamental science and translational initiatives enabled personalized, mutation specific treatment. We highlight the importance of preclinical assays and mechanistically-driven development strategies that were coupled with sensitive biomarkers and a clinical trial cooperative to provide a platform for successful drug development. This convergence of academic and private partnerships, and formation of multidisciplinary care teams directed by evidence-based initiatives provide a seminal example of addressing the needs of individuals with a rare, but fatal genetic disease.
    MeSH term(s) Humans ; Cystic Fibrosis/therapy ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis Transmembrane Conductance Regulator/genetics ; Cystic Fibrosis Transmembrane Conductance Regulator/therapeutic use ; Biomarkers ; Precision Medicine ; Mutation
    Chemical Substances Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6) ; Biomarkers
    Language English
    Publishing date 2023-01-06
    Publishing country Netherlands
    Document type Review ; Journal Article
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-323-85538-9.00006-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Reply to Martin

    Nichols, David P / Rowe, Steven M

    American journal of respiratory and critical care medicine

    2022  Volume 205, Issue 11, Page(s) 1366–1367

    MeSH term(s) Aminophenols/therapeutic use ; Benzodioxoles/therapeutic use ; Humans ; Indoles ; Lung ; Pyrazoles/adverse effects ; Pyridines ; Pyrrolidines ; Quinolones
    Chemical Substances Aminophenols ; Benzodioxoles ; Indoles ; Pyrazoles ; Pyridines ; Pyrrolidines ; Quinolones ; tezacaftor ; ivacaftor (1Y740ILL1Z) ; elexacaftor (RRN67GMB0V)
    Language English
    Publishing date 2022-04-02
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202201-0042LE
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: A little CFTR can change a lot: slowing cystic fibrosis progression.

    Rowe, Steven M

    The Lancet. Respiratory medicine

    2016  Volume 5, Issue 2, Page(s) 86–87

    MeSH term(s) Aminophenols ; Cystic Fibrosis ; Cystic Fibrosis Transmembrane Conductance Regulator/genetics ; Humans ; Mutation ; Quinolones
    Chemical Substances Aminophenols ; Quinolones ; Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6)
    Language English
    Publishing date 2016-12-21
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 2686754-0
    ISSN 2213-2619 ; 2213-2600
    ISSN (online) 2213-2619
    ISSN 2213-2600
    DOI 10.1016/S2213-2600(16)30465-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Revealing the molecular signaling pathways of mucus stasis in cystic fibrosis.

    Birket, Susan E / Rowe, Steven M

    The Journal of clinical investigation

    2019  Volume 129, Issue 10, Page(s) 4089–4090

    Abstract: Mucus obstruction is a hallmark of cystic fibrosis (CF) airway disease, leading to chronic infection, dysregulated inflammation, and progressive lung disease. As mucus hyperexpression is a key component in the initiation and perpetuation of airway ... ...

    Abstract Mucus obstruction is a hallmark of cystic fibrosis (CF) airway disease, leading to chronic infection, dysregulated inflammation, and progressive lung disease. As mucus hyperexpression is a key component in the initiation and perpetuation of airway obstruction, the triggers underlying mucin release must be identified and understood. In this issue of the JCI, Chen et al. sought to delineate the mechanisms that allow IL-1α/IL-1β to perpetuate the mucoinflammatory environment characteristic of the CF airway. The authors demonstrated that IL-1α and IL-1β stimulated non-CF human bronchial epithelial (HBE) cells to upregulate and secrete both MUC5B and MUC5AC in a dose-dependent manner, an effect that was neutralized by the inhibition of the IL-1α/IL-1β receptor (IL-1R1). Further experiments using mouse models and excised lung tissue identified contributors that drive a vicious feedback cycle of hyperconcentrated mucus secretions and persistent inflammation in the CF airway, factors that are likely at the nidus of progressive lung disease.
    MeSH term(s) Animals ; Cystic Fibrosis ; Humans ; Mice ; Mucin 5AC ; Mucin-5B ; Mucus ; Signal Transduction
    Chemical Substances Mucin 5AC ; Mucin-5B
    Language English
    Publishing date 2019-09-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 3067-3
    ISSN 1558-8238 ; 0021-9738
    ISSN (online) 1558-8238
    ISSN 0021-9738
    DOI 10.1172/JCI131652
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: An ex vivo rat trachea model reveals abnormal airway physiology and a gland secretion defect in cystic fibrosis.

    Harris, Elex / Easter, Molly / Ren, Janna / Krick, Stefanie / Barnes, Jarrod / Rowe, Steven M

    PloS one

    2023  Volume 18, Issue 10, Page(s) e0293367

    Abstract: Cystic fibrosis (CF) is a genetic disease hallmarked by aberrant ion transport that results in delayed mucus clearance, chronic infection, and progressive lung function decline. Several animal models have been developed to study the airway anatomy and ... ...

    Abstract Cystic fibrosis (CF) is a genetic disease hallmarked by aberrant ion transport that results in delayed mucus clearance, chronic infection, and progressive lung function decline. Several animal models have been developed to study the airway anatomy and mucus physiology in CF, but they are costly and difficult to maintain, making them less accessible for many applications. A more available CFTR-/- rat model has been developed and characterized to develop CF airway abnormalities, but consistent dosing of pharmacologic agents and longitudinal evaluation remain a challenge. In this study, we report the development and characterization of a novel ex vivo trachea model that utilizes both wild type (WT) and CFTR-/- rat tracheae cultured on a porcine gelatin matrix. Here we show that the ex vivo tracheae remain viable for weeks, maintain a CF disease phenotype that can be readily quantified, and respond to stimulation of mucus and fluid secretion by cholinergic stimulation. Furthermore, we show that ex vivo tracheae may be used for well-controlled pharmacological treatments, which are difficult to perform on freshly excised trachea or in vivo models with this degree of scrutiny. With improved interrogation possible with a durable trachea, we also established firm evidence of a gland secretion defect in CFTR-/- rat tracheae compared to WT controls. Finally, we demonstrate that the ex vivo tracheae can be used to generate high mucus protein yields for subsequent studies, which are currently limited by in vivo mucus collection techniques. Overall, this study suggests that the ex vivo trachea model is an effective, easy to set up culture model to study airway and mucus physiology.
    MeSH term(s) Swine ; Animals ; Rats ; Cystic Fibrosis/genetics ; Cystic Fibrosis Transmembrane Conductance Regulator/metabolism ; Trachea/metabolism ; Biological Transport ; Mucus/metabolism
    Chemical Substances Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6)
    Language English
    Publishing date 2023-10-24
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0293367
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  6. Article ; Online: The effect of CFTR modulators on a cystic fibrosis patient presenting with recurrent pancreatitis in the absence of respiratory symptoms: a case report.

    Johns, J Dixon / Rowe, Steven M

    BMC gastroenterology

    2019  Volume 19, Issue 1, Page(s) 123

    Abstract: Background: Cystic fibrosis (CF) is a genetic disorder of the epithelial CFTR apical chloride channel resulting in multi-organ manifestations, including pancreatic exocrine secretion. In the pancreas, CFTR abnormality results in abnormally viscous ... ...

    Abstract Background: Cystic fibrosis (CF) is a genetic disorder of the epithelial CFTR apical chloride channel resulting in multi-organ manifestations, including pancreatic exocrine secretion. In the pancreas, CFTR abnormality results in abnormally viscous secretions that obstruct proximal ducts leading to fibrotic injury and ultimately pancreatic insufficiency in 85% of the CF population. CFTR modulators, including the potentiator ivacaftor, augment channel gating to restore 30-50% of CFTR-mediated anion transport. While CFTR modulation has been shown to alkalinize the pH of the alimentary tract and potentially augment pancreatic enzyme activity, the effect of ivacaftor on recurrent pancreatitis is emerging. Here we describe a case of a patient with CF (R117H/7 T/F508del) who presented with recurrent pancreatitis who was effectively treated with ivacaftor in the absence of respiratory symptoms.
    Case presentation: A 24-year-old white male with past medical history of recurrent acute pancreatitis presented for evaluation following a referral from an outside hospital. The patient reported a lifetime of gastrointestinal symptoms requiring over 20 hospitalizations for pancreatitis in the last 10 years. Prior U/S and CT imaging for pancreatitis ruled out gallstones or anatomical etiologies. Family history included a brother with CF carrier status who suffered from recurrent acute pancreatitis. Sweat chloride testing was suggestive of CFTR dysfunction (57 mmol/L). Genetic testing demonstrated disease causing CFTR mutations: R1117H/7 T/F508del. Patient was prescribed pancrelipase, however, he reported worsened gas and diarrhea symptoms. Pancrelipase was discontinued and the patient was prescribed ivacaftor 150 mg BID. After 6 weeks of ivacaftor treatment, patient reported improved gastrointestinal symptoms. For an additional 19 months, patient reported no episodes of pancreatitis until he discontinued ivacaftor. Over the next 3 weeks, patient experienced progressive nausea and sharp epigastric pain and laboratory studies confirmed pancreatitis. Patient was subsequently lost to follow up.
    Conclusions: These findings support a possible relationship between the use of CFTR modulators, such as ivacaftor, in the management of recurrent pancreatitis in the setting of patients with cystic fibrosis and a CFTR mutation with residual CFTR activity or otherwise known to be responsive in vitro. Ivacaftor may be useful for recurrent pancreatitis, even in the absence of respiratory morbidity.
    MeSH term(s) Aminophenols/therapeutic use ; Cystic Fibrosis/complications ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis/genetics ; Cystic Fibrosis Transmembrane Conductance Regulator/drug effects ; Humans ; Male ; Pancreatitis, Chronic/drug therapy ; Pancreatitis, Chronic/genetics ; Quinolones/therapeutic use ; Recurrence ; Treatment Outcome ; Young Adult
    Chemical Substances Aminophenols ; CFTR protein, human ; Quinolones ; Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6) ; ivacaftor (1Y740ILL1Z)
    Language English
    Publishing date 2019-07-11
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1471-230X
    ISSN (online) 1471-230X
    DOI 10.1186/s12876-019-1044-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Cystic Fibrosis: Emergence of Highly Effective Targeted Therapeutics and Potential Clinical Implications.

    Mall, Marcus A / Mayer-Hamblett, Nicole / Rowe, Steven M

    American journal of respiratory and critical care medicine

    2020  Volume 201, Issue 10, Page(s) 1193–1208

    Abstract: Cystic fibrosis (CF) remains the most common life-shortening hereditary disease in white populations, with high morbidity and mortality related to chronic airway mucus obstruction, inflammation, infection, and progressive lung damage. In 1989, the ... ...

    Abstract Cystic fibrosis (CF) remains the most common life-shortening hereditary disease in white populations, with high morbidity and mortality related to chronic airway mucus obstruction, inflammation, infection, and progressive lung damage. In 1989, the discovery that CF is caused by mutations in the
    MeSH term(s) Aminophenols/therapeutic use ; Aminopyridines/therapeutic use ; Benzodioxoles/therapeutic use ; Chloride Channel Agonists/therapeutic use ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis/genetics ; Cystic Fibrosis/metabolism ; Cystic Fibrosis Transmembrane Conductance Regulator/genetics ; Cystic Fibrosis Transmembrane Conductance Regulator/metabolism ; Epithelial Sodium Channel Blockers/therapeutic use ; Humans ; Indoles/therapeutic use ; Molecular Targeted Therapy ; Mucociliary Clearance ; Mutation ; Precision Medicine ; Pyrazoles/therapeutic use ; Pyridines/therapeutic use ; Pyrrolidines/therapeutic use ; Quinolones/therapeutic use
    Chemical Substances Aminophenols ; Aminopyridines ; Benzodioxoles ; Chloride Channel Agonists ; Epithelial Sodium Channel Blockers ; Indoles ; Pyrazoles ; Pyridines ; Pyrrolidines ; Quinolones ; tezacaftor ; Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6) ; ivacaftor (1Y740ILL1Z) ; lumacaftor (EGP8L81APK) ; elexacaftor (RRN67GMB0V)
    Language English
    Publishing date 2020-02-18
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.201910-1943SO
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Triple Therapy for Cystic Fibrosis with a Phe508del CFTR Mutation. Reply.

    Jain, Raksha / Middleton, Peter G / Rowe, Steven M

    The New England journal of medicine

    2020  Volume 382, Issue 7, Page(s) 684

    MeSH term(s) Aminophenols ; Chloride Channel Agonists ; Cystic Fibrosis ; Cystic Fibrosis Transmembrane Conductance Regulator/genetics ; Humans ; Mutation
    Chemical Substances Aminophenols ; Chloride Channel Agonists ; Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6)
    Language English
    Publishing date 2020-01-01
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc1916747
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Pharmacological approaches for targeting cystic fibrosis nonsense mutations.

    Sharma, Jyoti / Keeling, Kim M / Rowe, Steven M

    European journal of medicinal chemistry

    2020  Volume 200, Page(s) 112436

    Abstract: Cystic fibrosis (CF) is a monogenic autosomal recessive disorder. The clinical manifestations of the disease are caused by ∼2,000 mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. It is unlikely that any one approach ... ...

    Abstract Cystic fibrosis (CF) is a monogenic autosomal recessive disorder. The clinical manifestations of the disease are caused by ∼2,000 mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein. It is unlikely that any one approach will be efficient in correcting all defects. The recent approvals of ivacaftor, lumacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor represent the genesis of a new era of precision combination medicine for the CF patient population. In this review, we discuss targeted translational readthrough approaches as mono and combination therapies for CFTR nonsense mutations. We examine the current status of efficacy of translational readthrough/nonsense suppression therapies and their limitations, including non-native amino acid incorporation at PTCs and nonsense-mediated mRNA decay (NMD), along with approaches to tackle these limitations. We further elaborate on combining various therapies such as readthrough agents, NMD inhibitors, and corrector/potentiators to improve the efficacy and safety of suppression therapy. These mutation specific strategies that are directed towards the basic CF defects should positively impact CF patients bearing nonsense mutations.
    MeSH term(s) Aminophenols/pharmacology ; Aminopyridines/pharmacology ; Animals ; Benzodioxoles/pharmacology ; Codon, Nonsense/drug effects ; Codon, Nonsense/genetics ; Cystic Fibrosis/drug therapy ; Cystic Fibrosis/genetics ; Dose-Response Relationship, Drug ; Humans ; Indoles/pharmacology ; Molecular Structure ; Mutation ; Pyrazoles/pharmacology ; Pyridines/pharmacology ; Pyrrolidines/pharmacology ; Quinolones/pharmacology ; Structure-Activity Relationship
    Chemical Substances Aminophenols ; Aminopyridines ; Benzodioxoles ; Codon, Nonsense ; Indoles ; Pyrazoles ; Pyridines ; Pyrrolidines ; Quinolones ; tezacaftor ; ivacaftor (1Y740ILL1Z) ; lumacaftor (EGP8L81APK) ; elexacaftor (RRN67GMB0V)
    Language English
    Publishing date 2020-05-21
    Publishing country France
    Document type Journal Article ; Review
    ZDB-ID 188597-2
    ISSN 1768-3254 ; 0009-4374 ; 0223-5234
    ISSN (online) 1768-3254
    ISSN 0009-4374 ; 0223-5234
    DOI 10.1016/j.ejmech.2020.112436
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Cystic fibrosis transmembrane conductance regulator in COPD: a role in respiratory epithelium and beyond.

    Mall, Marcus A / Criner, Gerard J / Miravitlles, Marc / Rowe, Steven M / Vogelmeier, Claus F / Rowlands, David J / Schoenberger, Matthias / Altman, Pablo

    The European respiratory journal

    2023  Volume 61, Issue 4

    Abstract: The cystic fibrosis transmembrane conductance regulator (CFTR) is a crucial ion channel for transport of chloride and bicarbonate anions. Functional roles of CFTR have been identified in a broad range of cell types including epithelial, endothelial, ... ...

    Abstract The cystic fibrosis transmembrane conductance regulator (CFTR) is a crucial ion channel for transport of chloride and bicarbonate anions. Functional roles of CFTR have been identified in a broad range of cell types including epithelial, endothelial, immune and structural cells. While CFTR has been investigated largely in the context of inborn dysfunction in cystic fibrosis, recent evidence shows that CFTR is also affected by acquired dysfunction in COPD. In patients with COPD and smokers, CFTR impairment has been demonstrated in the upper and lower airways, sweat glands and intestines, suggesting both pulmonary and systemic defects. Cigarette smoke, a key factor in COPD development, is the major cause of acquired CFTR dysfunction. Inflammation, bacterial byproducts and reactive oxygen species can further impair CFTR expression and function. CFTR dysfunction could contribute directly to disease manifestation and progression of COPD including disturbed airway surface liquid homeostasis, airway mucus obstruction, pathogen colonisation and inflammation. Mucus plugging and neutrophilic inflammation contribute to tissue destruction, development of dysfunction at the level of the small airways and COPD progression. Acquired CFTR dysfunction in extrapulmonary organs could add to common comorbidities and the disease burden. This review explores how CFTR dysfunction may be acquired and its potential effects on patients with COPD, particularly those with chronic bronchitis. The development of CFTR potentiators and the probable benefits of CFTR potentiation to improve tissue homeostasis, reduce inflammation, improve host defence and potentially reduce remodelling in the lungs will be discussed.
    MeSH term(s) Humans ; Cystic Fibrosis Transmembrane Conductance Regulator/metabolism ; Pulmonary Disease, Chronic Obstructive/metabolism ; Lung/metabolism ; Respiratory Mucosa/metabolism ; Inflammation
    Chemical Substances Cystic Fibrosis Transmembrane Conductance Regulator (126880-72-6)
    Language English
    Publishing date 2023-04-01
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 639359-7
    ISSN 1399-3003 ; 0903-1936
    ISSN (online) 1399-3003
    ISSN 0903-1936
    DOI 10.1183/13993003.01307-2022
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