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Physiological study of pulmonary involvement in adults with cystic fibrosis through simulated modeling of different clinical scenarios

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Abstract

Cystic fibrosis is an inherited disorder of the cystic fibrosis transmembrane conductance regulator gene (CFTR) that affects the respiratory system. Current treatment is palliative, but there is a gene therapy under investigation which involves inserting a functional CFTR gene into affected cells. Given the clinical variety of the disease, it is necessary to characterize key indicators in its evolution (e.g., the number of functional alveolar sacs and its relationship with a healthy lung function), to anticipate its advancement. A dynamic model was used to evaluate the evolution of cystic fibrosis over time. We considered the application of conventional medical treatments and evaluated the benefits of the application of an experimental gene therapy that would reverse lung damage. Without treatment the life expectancy of the patient is low, but it is increased with the application of conventional treatments, being the progressive loss of the lung function inevitable. Simulating the application of a gene therapy, the life expectancy of patients would not be limited, given the recovery of all altered cellular processes. With this model we can make predictions that demonstrate the need for a curative treatment, in addition to presenting the evolution of pathology in a specific clinical setting.

Graphic representation of the analysis performed in the present work on simulation of different clinical situations regarding patients with cystic fibrosis of pulmonary involvement.

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References

  1. Astrup F, Andersen OS, Jorgensen K, Engel K (1960) The acid-base metabolism: a new approach. Lancet 275(7133):1035–1039. https://doi.org/10.1016/S0140-6736(60)90930-2

    Article  Google Scholar 

  2. Bansal A, Mayer-Hamblett N, Goss CH, Heagerty PJ (2017) A novel tool to evaluate the accuracy of predicting survival in cystic fibrosis. arXiv preprint arXiv:1706.09602

  3. Bates JHT, Hunter IW, Sly PD, Okubo S, Filiatrault S, Milic-Emili J (1987) Effect of valve closure time on the determination of respiratory resistance by flow interruption. Med Biol Eng Comput 25(2):136–140. https://doi.org/10.1007/BF02442841

    Article  CAS  PubMed  Google Scholar 

  4. Bobadilla JL, Macek M, Fine JP, Farrell PM (2002) Cystic fibrosis: a worldwide analysis of CFTR mutations-correlation with incidence data and application to screening. Hum Mutat 19(6):575–606. https://doi.org/10.1002/humu.10041

    Article  CAS  PubMed  Google Scholar 

  5. Borriello G, Werner E, Roe F, Kim AM, Ehrlich GD, Stewart PS (2004) Oxygen limitation contributes to antibiotic tolerance of Pseudomonas aeruginosa in biofilms. Antimicrob Agents CH 48(7):2659–2664. https://doi.org/10.1128/AAC.48.7.2659-2664.2004

    Article  CAS  Google Scholar 

  6. Boucher RC (1999) Status of gene therapy for cystic fibrosis lung disease. J Clin Invest 103(4):441–445. https://doi.org/10.1172/JCI6330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bragonzi A, Horati H, Kerrigan L, Lorè NI, Scholte BJ, Weldon S (2017) Inflammation and host-pathogen interaction: cause and consequence in cystic fibrosis lung disease. J Cyst Fibros 17(2):40–45. https://doi.org/10.1016/j.jcf.2017.10.004

    Article  CAS  Google Scholar 

  8. Cantón R, Cobos N, De Gracia J, Baquero F, Honorato J, Gartner S, Álvarez A, Salcedo A, Oliver E, García-Quetglas E (2005) Tratamiento antimicrobiano frente a la colonización pulmonar por Pseudomonas aeruginosa en el paciente con fibrosis quística. Arch Bronconeumol 41:1–25. https://doi.org/10.1016/S0300-2896(05)70731-6

    Article  PubMed Central  Google Scholar 

  9. Chow L, Brown NE, Kunimoto D (2002) An unusual case of pulmonary invasive aspergillosis and aspergilloma cured with voriconazole in a patient with cystic fibrosis. Clin Infect Dis 35(9):106–110. https://doi.org/10.1086/343743

    Article  Google Scholar 

  10. Collins FC, Kimball GE (1949) Diffusion-controlled reaction rates. J Coll Sci Imp U Tok 4(4):425–437. https://doi.org/10.1016/0095-8522(49)90023-9

    Article  CAS  Google Scholar 

  11. Corey M, Farewell V (1996) Determinants of mortality from cystic fibrosis in Canada, 1970–1989. Am J Epidemiol 143(10):1007–1017. https://doi.org/10.1093/oxfordjournals.aje.a008664

    Article  CAS  PubMed  Google Scholar 

  12. Craig WA, Ebert SC (1991) Killing and regrowth of bacteria in vitro: a review. Scand J Infect Dis 74(Suppl):63–70. https://doi.org/10.3109/inf.1990.22.suppl-74.01

    Article  Google Scholar 

  13. Crossle J, Elliot RB, Smith P (1979) Dried-blood spot screening for cystic fibrosis in the newborn. Lancet 313(8114):472–474. https://doi.org/10.1016/S0140-6736(79)90825-0

    Article  Google Scholar 

  14. Davies G, Reid L (1970) Growth of the alveoli and pulmonary arteries in childhood. Thorax 25(6):669–681. https://doi.org/10.1136/thx.25.6.669

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Davies JC, Geddes DM, Alton EW (2001) Gene therapy for cystic fibrosis. J Gene Med 3(5):409–417. https://doi.org/10.1002/jgm.200

    Article  CAS  PubMed  Google Scholar 

  16. De Boeck K, Wilschanski M, Castellani C, Taylor C, Cuppens H, Dodge J, Sinaasappel M (2006) Cystic fibrosis: terminology and diagnostic algorithms. Thorax 61(7):627–635. https://doi.org/10.1136/thx.2005.043539

    Article  PubMed  Google Scholar 

  17. Desmond KJ, Schwenk WF, Thomas E, Beaudry PH, Coates AL (1983) Immediate and long-term effects of chest physiotherapy in patients with cystic fibrosis. J Pediatr 103(4):538–542. https://doi.org/10.1016/S0022-3476(83)80579-4

    Article  CAS  PubMed  Google Scholar 

  18. Elkins MR, Robinson M, Rose BR, Harbour C, Moriarty CP, Marks GB, Belousova EG, Xuan W, Bye PT (2006) A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. New Engl J Med 354(3):229–240. https://doi.org/10.1056/NEJMoa043900

    Article  CAS  PubMed  Google Scholar 

  19. Farrell PM (2008) The prevalence of cystic fibrosis in the European Union. J Cyst Fibros 7(5):450–453. https://doi.org/10.1016/j.jcf.2008.03.007

    Article  PubMed  Google Scholar 

  20. Ferrari S, Geddes DM, Alton EW (2002) Barriers to and new approaches for gene therapy and gene delivery in cystic fibrosis. Adv Drug Deliver Rev 54(11):1373–1393. https://doi.org/10.1016/S0169-409X(02)00145-X

    Article  CAS  Google Scholar 

  21. Fisher KJ, Choi H, Burda J, Chen SJ, Wilson JM (1996) Recombinant adenovirus deleted of all viral genes for gene therapy of cystic fibrosis. Virology 217(1):11–22. https://doi.org/10.1006/viro.1996.0088

    Article  CAS  PubMed  Google Scholar 

  22. Flume PA, Mogayzel PJ Jr, Robinson KA, Goss CH, Rosenblatt RL, Kuhn RJ, Marshall BC (2009) Cystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations. Am J Respir Crit Care Med 180(9):802–808. https://doi.org/10.1164/rccm.200812-1845PP

    Article  PubMed  Google Scholar 

  23. Folke M, Cernerud L, Ekström M, Hök B (2003) Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput 41(4):377–383. https://doi.org/10.1007/BF02348078

    Article  CAS  PubMed  Google Scholar 

  24. Gibson RL, Burns JL, Ramsey BW (2003) Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Resp Crit Care 168(8):918–951. https://doi.org/10.1164/rccm.200304-505SO

    Article  Google Scholar 

  25. Ginn SL, Amaya AK, Alexander IE, Edelstein M, Abedi MR (2018) Gene therapy clinical trials worldwide to 2017: an update. J Gene Med 20(5):e3015. https://doi.org/10.1002/jgm.3015

    Article  PubMed  Google Scholar 

  26. González CG, Lise AV, Felpeto AB (2013) Tratamiento de datos con R, Statistica y SPSS. Ediciones Díaz de Santos. Madrid, Spain

  27. Guggino WB, Cebotaru L (2017) Adeno-Associated Virus (AAV) gene therapy for cystic fibrosis: current barriers and recent developments. Expert Opin Biol Ther 17(10):1265–1273. https://doi.org/10.1080/14712598.2017.1347630

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16(6):372–377. https://doi.org/10.1007/BF01735174

    Article  CAS  PubMed  Google Scholar 

  29. Hyde SC, Emsley P, Hartshorn MJ, Mimmack MM, Gileadi U (1990) Structural model of ATP-binding proteins associated with cystic fibrosis, multidrug resistance and bacterial transport. Nature 346(6282):362–365. https://doi.org/10.1038/346362a0

    Article  CAS  PubMed  Google Scholar 

  30. Johnson LG, Olsen JC, Sarkadi B, Moore KL, Swanstrom R, Boucher RC (1992) Efficiency of gene transfer for restoration of normal airway epithelial function in cystic fibrosis. Nat Genet 2(1):21–25. https://doi.org/10.1038/ng0992-21

    Article  CAS  PubMed  Google Scholar 

  31. Kahl B, Herrmann M, Everding AS, Koch HG, Becker K, Harms E, Proctor RA, Peters G (1998) Persistent infection with small colony variant strains of Staphylococcus aureus in patients with cystic fibrosis. J Infect Dis 177(4):1023–1029. https://doi.org/10.1086/515238

    Article  CAS  PubMed  Google Scholar 

  32. Koch C, Hoiby N (1993) Pathogenesis of cystic fibrosis. Lancet 341(8852):1065–1069. https://doi.org/10.1016/0140-6736(93)92422-P

    Article  CAS  PubMed  Google Scholar 

  33. Konstan MW, Hilliard KA, Norvell TM, Berger M (1994) Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggests ongoing infection and inflammation. Am J Respir Crit Care Med 150(2):448–454. https://doi.org/10.1164/ajrccm.150.2.8049828

    Article  CAS  PubMed  Google Scholar 

  34. Konstan MW, Byard PJ, Hoppel CL, Davis PB (1995) Effect of high-dose ibuprofen in patients with cystic fibrosis. New Engl J Med 332(13):848–854. https://doi.org/10.1056/NEJM199503303321303

    Article  CAS  PubMed  Google Scholar 

  35. Konstan MW, Morgan WJ, Butler SM, Pasta DJ, Craib ML, Silva SJ, Stokes DC, Wohl MEB, Wagener JS, Regelmann WE, Johnson CA (2007) Risk factors for rate of decline in forced expiratory volume in one second in children and adolescents with cystic fibrosis. J Pediatr 151(2):134–139. https://doi.org/10.1016/j.jpeds.2007.03.006

    Article  PubMed  Google Scholar 

  36. Lane S, Rippon HJ, Bishop AE (2007) Stem cells in lung repair and regeneration. Regen Med 2(4):407–415. https://doi.org/10.2217/17460751.2.4.407

    Article  CAS  PubMed  Google Scholar 

  37. Le Bourgeois M, Sermet I, Bailly-Botuha C, Delacourt C, De Blic J (2011) Fungal infections in cystic fibrosis. Archives de pediatrie: organe officiel de la Societe francaise de. pediatrie 18:15–21. https://doi.org/10.1016/S0929-693X(11)70936-8

    Article  Google Scholar 

  38. Madigan MT, Martinko JM, Parker J (2004) Brock biology of microorganism. Prentice Hall, New Jersey

    Google Scholar 

  39. Martínez-Garcia MA, Dimakou K (2018) COPD and bronchiectasis. In Bronchiectasis (pp. 107–127). Springer, Cham. https://doi.org/10.1007/978-3-319-61452-6_9

  40. Mekus F, Laabs U, Veeze H, Tümmler B (2003) Genes in the vicinity of CFTR modulate the cystic fibrosis phenotype in highly concordant or discordant F508del homozygous sib pairs. Hum Genet 112(1):1–11. https://doi.org/10.1007/s00439-002-0839-7

    Article  CAS  PubMed  Google Scholar 

  41. Microsoft ® Excel ® 2016 MSO (16.0.8625.2121) 32 bits. Product ID: 00334–38962-20716-AA945. Accessed 28 May 2018

  42. Microsoft ® PowerPoint ® 2016 MSO (16.0.8625.2121) 32 bits. Product ID: 00334–38962-20716-AA945. Accessed 21 May 2018

  43. Mitchell R, Kumar V, Abbas AK, Fausto N, Aster JC (2007) Patología estructural y funcional. Elsevier, Madrid

    Google Scholar 

  44. Morrissey BM (2007) Pathogenesis of bronchiectasis. Clin Chest Med 28(2):289–296. https://doi.org/10.1016/j.ccm.2007.02.014

    Article  PubMed  Google Scholar 

  45. Oblatt-Montal M, Reddy GL, Iwamoto T, Tomich JM, Montal M (1994) Identification of an ion channel-forming motif in the primary structure of CFTR, the cystic fibrosis chloride channel. Proc Natl Acad Sci 91(4):1495–1499. https://doi.org/10.1073/pnas.91.4.1495

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296(5570):1029–1031. https://doi.org/10.1126/science.1069675

    Article  CAS  PubMed  Google Scholar 

  47. Oliver A, Cantón R, Campo P, Baquero F, Blázquez J (2000) High frequency of hypermutable Pseudomonas aeruginosa in cystic fibrosis lung infection. Science 288(5469):1251–1253. https://doi.org/10.1126/science.288.5469.1251

    Article  CAS  PubMed  Google Scholar 

  48. Pastor FJ, Guarro J (2009) Micafungina en el tratamiento de la infección fúngica en modelos animales. Rev Iberoam Micol 26(1):42–48. https://doi.org/10.1016/S1130-1406(09)70007-5

    Article  Google Scholar 

  49. Patrick AE, Thomas PJ (2012) Development of CFTR structure. Front Pharmacol 3:162. https://doi.org/10.3389/fphar.2012.00162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Polgar G, Weng TR (1979) The functional development of the respiratory system: from the period of gestation to adulthood 1, 2. Am Rev Respir Dis 120(3):625–695. https://doi.org/10.1164/arrd.1979.120.3.625

    Article  CAS  PubMed  Google Scholar 

  51. Rahman RNZA, Geok LP, Basri M, Salleh AB (2005) Physical factors affecting the production of organic solvent-tolerant protease by Pseudomonas aeruginosa strain K. Bioresour Technol 96(4):429–436. https://doi.org/10.1016/j.biortech.2004.06.012

    Article  CAS  PubMed  Google Scholar 

  52. Rajan S, Cacalano G, Bryan R, Ratner AJ, Sontich CU, van Heerckeren A, Davis P, Prince A (2000) Pseudomonas aeruginosa induction of apoptosis in respiratory epithelial cells: analysis of the effects of cystic fibrosis transmembrane conductance regulator dysfunction and bacterial virulence factors. Am J Resp Cell Mol 23(3):304–312. https://doi.org/10.1165/ajrcmb.23.3.4098

    Article  CAS  Google Scholar 

  53. Robinson W (2000) Palliative care in cystic fibrosis. J Palliat Med 3(2):187–192. https://doi.org/10.1089/10966210050085250

    Article  CAS  PubMed  Google Scholar 

  54. Rosenstein BJ, Cutting GR (1998) The diagnosis of cystic fibrosis: a consensus statement. J Pediatr 132(4):589–595. https://doi.org/10.1016/S0022-3476(98)70344-0

    Article  CAS  PubMed  Google Scholar 

  55. Sainsbury KJ (1980) Effect of individual variability on the von Bertalanffy growth equation. Can J Fish Aquat Sci 37(2):241–247. https://doi.org/10.1139/f80-031

    Article  Google Scholar 

  56. Salh W, Bilton D, Dodd M, Webb AK (1989) Effect of exercise and physiotherapy in aiding sputum expectoration in adults with cystic fibrosis. Thorax 44(12):1006–1008. https://doi.org/10.1136/thx.44.12.1006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Sanders DB, Bittner RC, Rosenfeld M, Hoffman LR, Redding GJ, Goss CH (2010) Failure to recover to baseline pulmonary function after cystic fibrosis pulmonary exacerbation. Am J Resp Crit Care 182(5):627–632. https://doi.org/10.1164/rccm.200909-1421OC

    Article  Google Scholar 

  58. Schüler D, Sermet-Gaudelus I, Wilschanski M, Ballmann M, Dechaux M, Edelman A, Martin H, Leaf T, Lebacq J, Lebecque P, Lenoir G, Stanke F, Wallemacq P, Tümmler B, Knowles MR (2004) Basic protocol for transepithelial nasal potential difference measurements. J Cyst Fibros 3:151–155. https://doi.org/10.1016/j.jcf.2004.05.032

    Article  CAS  PubMed  Google Scholar 

  59. Segrelles G, Romero-de Tejada JG, Gómez-Púnter RM, Cano P, Martín C, Pinedo C, Girón RM (2009) Aspergiloma pulmonar con buena respuesta a antifúngico. Revista de Patología Respiratoria 12(3):124–127. https://doi.org/10.1016/S1576-9895(09)70059-1

    Article  Google Scholar 

  60. Steinbach WJ, Cramer RA, Perfect BZ, Asfaw YG, Sauer TC, Najvar LK, Kirkpatrick WR, Patterson TF, Benjamin DK Jr, Heitman J, Perfect JR (2006) Calcineurin controls growth, morphology, and pathogenicity in Aspergillus fumigatus. Eukaryot Cell 5(7):1091–1103. https://doi.org/10.1128/EC.00139-06

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. STELLA (2010) STELLA 9.1.4. Dynamic System Software. Isee System Inc. https://www.iseesystems.com/store/products/stella-online.aspx. Accessed 19 June 2018.

  62. Stern RC (1997) The diagnosis of cystic fibrosis. New Engl J Med 336(7):487–491. https://doi.org/10.1056/NEJM199702133360707

    Article  CAS  PubMed  Google Scholar 

  63. Tümmler B, Kiewitz C (1999) Cystic fibrosis: an inherited susceptibility to bacterial respiratory infections. Mol Med Today 5(8):351–358. https://doi.org/10.1016/S1357-4310(99)01506-3

    Article  PubMed  Google Scholar 

  64. Van Der Schans CP, Postma DS, Koeter GH, Rubin BK (1999) Physiotherapy and bronchial mucus transport. Eur Respir J 13(6):1477–1486. https://doi.org/10.1034/j.1399-3003.1999.13f37.x

    Article  PubMed  Google Scholar 

  65. Vega-Briceño LE, Sánchez D (2005) Fibrosis quística: Actualización en sus aspectos básicos. Rev Chil Pediatr 76(5):464–470. https://doi.org/10.4067/S0370-41062005000500002

    Article  Google Scholar 

  66. Von Bertalanffy L (1938) A quantitative theory of organic growth (inquiries on growth laws. II). Hum Biol 10(2):181–213

    Google Scholar 

  67. West JB (2012) Respiratory physiology: the essentials. Lippincott Williams & Wilkins, Baltimore

    Google Scholar 

  68. Wheeler KA, Hurdman BF, Pitt JI (1991) Influence of pH on the growth of some toxigenic species of Aspergillus, Penicillium and Fusarium. Int J Food Microbiol 12(2–3):141–149. https://doi.org/10.1016/0168-1605(91)90063-U

    Article  CAS  PubMed  Google Scholar 

  69. Whitsett JA, Wert SE, Weaver TE (2010) Alveolar surfactant homeostasis and the pathogenesis of pulmonary disease. Annu Rev Med 61:105–119. https://doi.org/10.1146/annurev.med.60.041807.123500

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Zabner J, Couture LA, Gregory RJ, Graham SM, Smith AE, Welsh MJ (1993) Adenovirus-mediated gene transfer transiently corrects the chloride transport defect in nasal epithelia of patients with cystic fibrosis. Cell 75(2):207–216. https://doi.org/10.1016/0092-8674(93)80063-K

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Authors want to thank the support received for this work by a predoctoral contract of researcher in training (UCM-Santander scholarship) granted by University Complutense of Madrid to Antonio Alberto Rodríguez Sousa and a predoctoral scholarship granted to Jonathan Pereira Miller. Finally, special thanks to Ms. María Aurora Rodríguez Sousa, for her unconditional support and advice in carrying out this work from its inception. In Memoriam: Sergio Rodríguez Valido.

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Rodríguez Sousa, A.A., Barandica Fernández, J.M., Miller, J. et al. Physiological study of pulmonary involvement in adults with cystic fibrosis through simulated modeling of different clinical scenarios. Med Biol Eng Comput 57, 413–425 (2019). https://doi.org/10.1007/s11517-018-1885-1

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