Cystic fibrosis is the most common life-shortening autosomalrecessive disorder in the white population, affecting approximately30,000 persons in the United States.1 It is caused by mutationsin a single gene on the long arm of chromosome 7 that encodesthe cystic fibrosis transmembrane conductance regulator (CFTR)(Figure 1).2 CFTR has multiple functions involving fluid balanceacross epithelial cells. It acts as a chloride channel activatedby cyclic adenosine monophosphate (cAMP)3 and may stimulateother chloride channels4 and inhibit sodium absorption by epithelialsodium channels.5
View larger version (28K): [in this window]
[in a new window]
Figure 1. Gene, Transcript, and Predicted Structure of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) . . . [Full Text of this Article]
Conventional Pulmonary Therapy for Cystic Fibrosis
Clearance of Airway Secretions
Bronchodilator Therapy
Reduction in the Viscoelasticity of Sputum
Antibiotic Therapy
Exacerbations of Pulmonary Infection
Maintenance Antibiotic Therapy
Quinolone Therapy
Inhaled Antibiotic Therapy
Gene Therapy
Pharmacologic Modulation of Ion Transport
Inhibition of Sodium Absorption
Activation of Alternative Chloride Channels
Antiinflammatory-Drug Therapy
Conclusions
Source Information
From the Department of Pediatrics, University of Washington School of Medicine, Seattle.
Address reprint requests to Dr. Ramsey at the Cystic Fibrosis Research Center, University of Washington School of Medicine, Department of Pediatrics, Box 359301, Seattle, WA 98195.
References
This article has been cited by other articles:
Rogers, G. B., Carroll, M. P., Bruce, K. D.
(2009). Studying bacterial infections through culture-independent approaches. J Med Microbiol
58: 1401-1418
[Abstract][Full Text]
Moreau-Marquis, S., O'Toole, G. A., Stanton, B. A.
(2009). Tobramycin and FDA-Approved Iron Chelators Eliminate Pseudomonas aeruginosa Biofilms on Cystic Fibrosis Cells. Am. J. Respir. Cell Mol. Bio.
41: 305-313
[Abstract][Full Text]
Vettoretti, L., Plesiat, P., Muller, C., El Garch, F., Phan, G., Attree, I., Ducruix, A., Llanes, C.
(2009). Efflux Unbalance in Pseudomonas aeruginosa Isolates from Cystic Fibrosis Patients. Antimicrob. Agents Chemother.
53: 1987-1997
[Abstract][Full Text]
Strateva, T., Petrova, G., Perenovska, P., Mitov, I.
(2009). Bulgarian cystic fibrosis Pseudomonas aeruginosa isolates: antimicrobial susceptibility and neuraminidase-encoding gene distribution. J Med Microbiol
58: 690-692
[Full Text]
Moores, L. K.
(2009). Unusual Lung Infection, Bronchiectasis, and Cystic Fibrosis. ACCP Pulmonary Med Brd Rev
25: 1-20
[Full Text]
Skindersoe, M. E., Alhede, M., Phipps, R., Yang, L., Jensen, P. O., Rasmussen, T. B., Bjarnsholt, T., Tolker-Nielsen, T., Hoiby, N., Givskov, M.
(2008). Effects of Antibiotics on Quorum Sensing in Pseudomonas aeruginosa. Antimicrob. Agents Chemother.
52: 3648-3663
[Abstract][Full Text]
Kukavica-Ibrulj, I, Levesque, R C
(2008). Animal models of chronic lung infection with Pseudomonas aeruginosa: useful tools for cystic fibrosis studies. Lab Anim
42: 389-412
[Abstract][Full Text]
Tai, A
(2008). Renal impairment following aminoglycoside therapy in cystic fibrosis. Thorax
63: 936-936
[Full Text]
Khalil, H., Chen, T., Riffon, R., Wang, R., Wang, Z.
(2008). Synergy between Polyethylenimine and Different Families of Antibiotics against a Resistant Clinical Isolate of Pseudomonas aeruginosa. Antimicrob. Agents Chemother.
52: 1635-1641
[Abstract][Full Text]
Kremer, T. M., Zwerdling, R. G., Michelson, P. H., O'Sullivan, B. P.
(2008). Intensive Care Management of the Patient With Cystic Fibrosis. J Intensive Care Med
23: 159-177
[Abstract]
Jarad, N. A., Giles, K.
(2008). Risk factors for increased need for intravenous antibiotics for pulmonary exacerbations in adult patients with cystic fibrosis. Chronic Respiratory Disease
5: 29-33
[Abstract]
Deterding, R. R., LaVange, L. M., Engels, J. M., Mathews, D. W., Coquillette, S. J., Brody, A. S., Millard, S. P., Ramsey, B. W., for the Cystic Fibrosis Therapeutics Development N,
(2007). Phase 2 Randomized Safety and Efficacy Trial of Nebulized Denufosol Tetrasodium in Cystic Fibrosis. Am. J. Respir. Crit. Care Med.
176: 362-369
[Abstract][Full Text]
Lee, C. K. K., Boyle, M. P., Diener-West, M., Brass-Ernst, L., Noschese, M., Zeitlin, P. L.
(2007). Levofloxacin Pharmacokinetics in Adult Cystic Fibrosis. Chest
131: 796-802
[Abstract][Full Text]
Zhou, J., Chen, Y., Tabibi, S., Alba, L., Garber, E., Saiman, L.
(2007). Antimicrobial Susceptibility and Synergy Studies of Burkholderia cepacia Complex Isolated from Patients with Cystic Fibrosis. Antimicrob. Agents Chemother.
51: 1085-1088
[Abstract][Full Text]
Chen, D. L., Ferkol, T. W., Mintun, M. A., Pittman, J. E., Rosenbluth, D. B., Schuster, D. P.
(2006). Quantifying Pulmonary Inflammation in Cystic Fibrosis with Positron Emission Tomography. Am. J. Respir. Crit. Care Med.
173: 1363-1369
[Abstract][Full Text]
Barker, M., Hengst, M., Schmid, J., Buers, H-J., Mittermaier, B., Klemp, D., Koppmann, R.
(2006). Volatile organic compounds in the exhaled breath of young patients with cystic fibrosis. Eur Respir J
27: 929-936
[Abstract][Full Text]
Phaff, S. J., Tiddens, H. A. W. M., Verbrugh, H. A., Ott, A.
(2006). Macrolide resistance of Staphylococcus aureus and Haemophilus species associated with long-term azithromycin use in cystic fibrosis. J Antimicrob Chemother
57: 741-746
[Abstract][Full Text]
Sloane, A. J., Lindner, R. A., Prasad, S. S., Sebastian, L. T., Pedersen, S. K., Robinson, M., Bye, P. T., Nielson, D. W., Harry, J. L.
(2005). Proteomic Analysis of Sputum from Adults and Children with Cystic Fibrosis and from Control Subjects. Am. J. Respir. Crit. Care Med.
172: 1416-1426
[Abstract][Full Text]
Blumer, J. L., Saiman, L., Konstan, M. W., Melnick, D.
(2005). The Efficacy and Safety of Meropenem and Tobramycin vs Ceftazidime and Tobramycin in the Treatment of Acute Pulmonary Exacerbations in Patients With Cystic Fibrosis. Chest
128: 2336-2346
[Abstract][Full Text]
Bernier, S. P., Sokol, P. A.
(2005). Use of Suppression-Subtractive Hybridization To Identify Genes in the Burkholderia cepacia Complex That Are Unique to Burkholderia cenocepacia. J. Bacteriol.
187: 5278-5291
[Abstract][Full Text]
Choi, M. Y., Partridge, A. W., Daniels, C., Du, K., Lukacs, G. L., Deber, C. M.
(2005). Destabilization of the Transmembrane Domain Induces Misfolding in a Phenotypic Mutant of Cystic Fibrosis Transmembrane Conductance Regulator. J. Biol. Chem.
280: 4968-4974
[Abstract][Full Text]
Vogne, C., Aires, J. R., Bailly, C., Hocquet, D., Plesiat, P.
(2004). Role of the Multidrug Efflux System MexXY in the Emergence of Moderate Resistance to Aminoglycosides among Pseudomonas aeruginosa Isolates from Patients with Cystic Fibrosis. Antimicrob. Agents Chemother.
48: 1676-1680
[Abstract][Full Text]
Moskowitz, S. M., Foster, J. M., Emerson, J., Burns, J. L.
(2004). Clinically Feasible Biofilm Susceptibility Assay for Isolates of Pseudomonas aeruginosa from Patients with Cystic Fibrosis. J. Clin. Microbiol.
42: 1915-1922
[Abstract][Full Text]
Brody, A. S.
(2004). Scoring Systems for CT in Cystic Fibrosis: Who Cares?. Radiology
231: 296-298
[Full Text]
Groneberg, D. A., Fischer, A., Chung, K. F., Daniel, H.
(2004). Molecular Mechanisms of Pulmonary Peptidomimetic Drug and Peptide Transport. Am. J. Respir. Cell Mol. Bio.
30: 251-260
[Abstract][Full Text]
San Gabriel, P., Zhou, J., Tabibi, S., Chen, Y., Trauzzi, M., Saiman, L.
(2004). Antimicrobial Susceptibility and Synergy Studies of Stenotrophomonas maltophilia Isolates from Patients with Cystic Fibrosis. Antimicrob. Agents Chemother.
48: 168-171
[Abstract][Full Text]
Gibson, R. L., Burns, J. L., Ramsey, B. W.
(2003). Pathophysiology and Management of Pulmonary Infections in Cystic Fibrosis. Am. J. Respir. Crit. Care Med.
168: 918-951
[Abstract][Full Text]
Saiman, L., Marshall, B. C., Mayer-Hamblett, N., Burns, J. L., Quittner, A. L., Cibene, D. A., Coquillette, S., Fieberg, A. Y., Accurso, F. J., Campbell, P. W. III
(2003). Azithromycin in Patients With Cystic Fibrosis Chronically Infected With Pseudomonas aeruginosa: A Randomized Controlled Trial. JAMA
290: 1749-1756
[Abstract][Full Text]
Cannon, C. L., Kowalski, M. P., Stopak, K. S., Pier, G. B.
(2003). Pseudomonas aeruginosa-Induced Apoptosis Is Defective in Respiratory Epithelial Cells Expressing Mutant Cystic Fibrosis Transmembrane Conductance Regulator. Am. J. Respir. Cell Mol. Bio.
29: 188-197
[Abstract][Full Text]
O'Connor, G. T., Quinton, H. B., Kneeland, T., Kahn, R., Lever, T., Maddock, J., Robichaud, P., Detzer, M., Swartz, D. R.
(2003). Median Household Income and Mortality Rate in Cystic Fibrosis. Pediatrics
111: e333-339
[Abstract][Full Text]
Olivier, K. N., Weber, D. J., Wallace, R. J. Jr., Faiz, A. R., Lee, J.-H., Zhang, Y., Brown-Elliot, B. A., Handler, A., Wilson, R. W., Schechter, M. S., Edwards, L. J., Chakraborti, S., Knowles, M. R.
(2003). Nontuberculous Mycobacteria: I: Multicenter Prevalence Study in Cystic Fibrosis. Am. J. Respir. Crit. Care Med.
167: 828-834
[Abstract][Full Text]
Johnson, C., Butler, S. M., Konstan, M. W., Morgan, W., Wohl, M. E. B.
(2003). Factors Influencing Outcomes in Cystic Fibrosis: A Center-Based Analysis. Chest
123: 20-27
[Abstract][Full Text]
Yerxa, B. R., Sabater, J. R., Davis, C. W., Stutts, M. J., Lang-Furr, M., Picher, M., Jones, A. C., Cowlen, M., Dougherty, R., Boyer, J., Abraham, W. M., Boucher, R. C.
(2002). Pharmacology of INS37217 [P1-(Uridine 5')-P4- (2'-deoxycytidine 5')tetraphosphate, Tetrasodium Salt], a Next-Generation P2Y2 Receptor Agonist for the Treatment of Cystic Fibrosis. J. Pharmacol. Exp. Ther.
302: 871-880
[Abstract][Full Text]
Duff, A J A
(2002). Psychological consequences of segregation resulting from chronic Burkholderia cepacia infection in adults with CF. Thorax
57: 756-758
[Full Text]
West, S. E. H., Zeng, L., Lee, B. L., Kosorok, M. R., Laxova, A., Rock, M. J., Splaingard, M. J., Farrell, P. M.
(2002). Respiratory Infections With Pseudomonas aeruginosa in Children With Cystic Fibrosis: Early Detection by Serology and Assessment of Risk Factors. JAMA
287: 2958-2967
[Abstract][Full Text]
Lyczak, J. B., Cannon, C. L., Pier, G. B.
(2002). Lung Infections Associated with Cystic Fibrosis. Clin. Microbiol. Rev.
15: 194-222
[Abstract][Full Text]
Saiman, L., Chen, Y., Gabriel, P. S., Knirsch, C.
(2002). Synergistic Activities of Macrolide Antibiotics against Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans Isolated from Patients with Cystic Fibrosis. Antimicrob. Agents Chemother.
46: 1105-1107
[Abstract][Full Text]
Groneberg, D A, Eynott, P R, Doring, F, Thai Dinh, Q, Oates, T, Barnes, P J, Chung, K F, Daniel, H, Fischer, A
(2002). Distribution and function of the peptide transporter PEPT2 in normal and cystic fibrosis human lung. Thorax
57: 55-60
[Abstract][Full Text]
Sajjan, U. S., Tran, L. T., Sole, N., Rovaldi, C., Akiyama, A., Friden, P. M., Forstner, J. F., Rothstein, D. M.
(2001). P-113D, an Antimicrobial Peptide Active against Pseudomonas aeruginosa, Retains Activity in the Presence of Sputum from Cystic Fibrosis Patients. Antimicrob. Agents Chemother.
45: 3437-3444
[Abstract][Full Text]
Montgomery, M. J., Beringer, P. M., Aminimanizani, A., Louie, S. G., Shapiro, B. J., Jelliffe, R., Gill, M. A.
(2001). Population Pharmacokinetics and Use of Monte Carlo Simulation To Evaluate Currently Recommended Dosing Regimens of Ciprofloxacin in Adult Patients with Cystic Fibrosis. Antimicrob. Agents Chemother.
45: 3468-3473
[Abstract][Full Text]
Saiman, L., Chen, Y., Tabibi, S., San Gabriel, P., Zhou, J., Liu, Z., Lai, L., Whittier, S.
(2001). Identification and Antimicrobial Susceptibility of Alcaligenes xylosoxidans Isolated from Patients with Cystic Fibrosis. J. Clin. Microbiol.
39: 3942-3945
[Abstract][Full Text]
FRANZ, A. R., ROHLKE, W., FRANKE, R. P., EBSEN, M., POHLANDT, F., HUMMLER, H. D.
(2001). Pulmonary Administration of Perfluorodecaline- Gentamicin and Perfluorodecaline- Vancomycin Emulsions. Am. J. Respir. Crit. Care Med.
164: 1595-1600
[Abstract][Full Text]
MUTLU, G. M., GAREY, K. W., ROBBINS, R. A., DANZIGER, L. H., RUBINSTEIN, I.
(2001). Collection and Analysis of Exhaled Breath Condensate in Humans. Am. J. Respir. Crit. Care Med.
164: 731-737
[Full Text]
Schindler, R., Radke, C., Paul, K., Frei, U.
(2001). Renal problems after lung transplantation of cystic fibrosis patients. Nephrol Dial Transplant
16: 1324-1328
[Full Text]
Robinson, C. A., Kuhn, R. J.
(2001). Management of Pulmonary Disease in Patients with Cystic Fibrosis. Journal of Pharmacy Practice
14: 207-227
[Abstract]
Wang, S. S., FitzSimmons, S. C., O'Leary, L. A., Rock, M. J., Gwinn, M. L., Khoury, M. J.
(2001). Early Diagnosis of Cystic Fibrosis in the Newborn Period and Risk of Pseudomonas aeruginosa Acquisition in the First 10 Years of Life: A Registry-Based Longitudinal Study. Pediatrics
107: 274-279
[Abstract][Full Text]
Burns, J. L., Saiman, L., Whittier, S., Larone, D., Krzewinski, J., Liu, Z., Marshall, S. A., Jones, R. N.
(2000). Comparison of Agar Diffusion Methodologies for Antimicrobial Susceptibility Testing of Pseudomonas aeruginosa Isolates from Cystic Fibrosis Patients. J. Clin. Microbiol.
38: 1818-1822
[Abstract][Full Text]
Albelda, S. M., Wiewrodt, R., Zuckerman, J. B.
(2000). Gene Therapy for Lung Disease: Hype or Hope?. ANN INTERN MED
132: 649-660
[Abstract][Full Text]
Beringer, P. M., Vinks, A. A. T. M. M., Jelliffe, R. W., Shapiro, B. J.
(2000). Pharmacokinetics of Tobramycin in Adults with Cystic Fibrosis: Implications for Once-Daily Administration. Antimicrob. Agents Chemother.
44: 809-813
[Abstract][Full Text]
Ellsworth, R. E., Jamison, D. C., Touchman, J. W., Chissoe, S. L., Braden Maduro, V. V., Bouffard, G. G., Dietrich, N. L., Beckstrom-Sternberg, S. M., Iyer, L. M., Weintraub, L. A., Cotton, M., Courtney, L., Edwards, J., Maupin, R., Ozersky, P., Rohlfing, T., Wohldmann, P., Miner, T., Kemp, K., Kramer, J., Korf, I., Pepin, K., Antonacci-Fulton, L., Fulton, R. S., Minx, P., Hillier, L. W., Wilson, R. K., Waterston, R. H., Miller, W., Green, E. D.
(2000). Comparative genomic sequence analysis of the human and mouse cystic fibrosis transmembrane conductance regulator genes. Proc. Natl. Acad. Sci. USA
97: 1172-1177
[Abstract][Full Text]
Saiman, L., Burns, J. L., Whittier, S., Krzewinski, J., Marshall, S. A., Jones, R. N.
(1999). Evaluation of Reference Dilution Test Methods for Antimicrobial Susceptibility Testing of Pseudomonas aeruginosa Strains Isolated from Patients with Cystic Fibrosis. J. Clin. Microbiol.
37: 2987-2991
[Abstract][Full Text]
Fung, E. B., Barden, E. M., Wasserman, D., Zemel, B. S., Heinrich, B. T., Scanlin, T. F., Stallings, V. A.
(1999). A Six-Month Study of Growth and Energy Expenditure in Children with Cystic Fibrosis Taking a Pulmonary Inhalation Medication (rhDNase). J. Am. Coll. Nutr.
18: 330-338
[Abstract][Full Text]
ELBORN, J S
(1999). Treatment of Staphylococcus aureus in cystic fibrosis. Thorax
54: 377-378
[Full Text]
Dwyer, M. A., Huang, A. J., Pan, C. Q., Lazarus, R. A.
(1999). Expression and Characterization of a DNase I-Fc Fusion Enzyme. J. Biol. Chem.
274: 9738-9743
[Abstract][Full Text]
Ballmann, M., Rabsch, P., von der Hardt, H.
(1998). Long term follow up of changes in FEV1 and treatment intensity during Pseudomonas aeruginosa colonisation in patients with cystic fibrosis. Thorax
53: 732-737
[Abstract][Full Text]
Pan, C. Q., Dodge, T. H., Baker, D. L., Prince, W. S., Sinicropi, D. V., Lazarus, R. A.
(1998). Improved Potency of Hyperactive and Actin-resistant Human DNase I Variants for Treatment of Cystic Fibrosis and Systemic Lupus Erythematosus. J. Biol. Chem.
273: 18374-18381
[Abstract][Full Text]
Ramsey, B. W.
(1998). Pseudomonas aeruginosa Infection as a Complication of Therapy in Pancreatic Fibrosis (Mucoviscidosis), by Sterling D. Garrard, et al, Pediatrics, 1951;8:482. Pediatrics
102: 210-213
[Abstract][Full Text]
Pan, C. Q., Lazarus, R. A.
(1998). Hyperactivity of Human DNase I Variants. DEPENDENCE ON THE NUMBER OF POSITIVELY CHARGED RESIDUES AND CONCENTRATION, LENGTH, AND ENVIRONMENT OF DNA. J. Biol. Chem.
273: 11701-11708
[Abstract][Full Text]
WELSH, M. J., RAMSEY, B. W.
(1998). Research on Cystic Fibrosis . A Journey from the Heart House. Am. J. Respir. Crit. Care Med.
157: S148-S154
[Full Text]
FENG, W., GARRETT, H., SPEERT, D. P., KING, M.
(1998). Improved Clearability of Cystic Fibrosis Sputum with Dextran Treatment in vitro. Am. J. Respir. Crit. Care Med.
157: 710-714
[Abstract][Full Text]
Farrell, P. M., Shen, G., Splaingard, M., Colby, C. E., Laxova, A., Kosorok, M. R., Rock, M. J., Mischler, E. H.
(1997). Acquisition of Pseudomonas aeruginosa in Children With Cystic Fibrosis. Pediatrics
100: e2-e2
[Abstract][Full Text]
Ackerman, M. J., Clapham, D. E.
(1997). Ion Channels -- Basic Science and Clinical Disease. NEJM
336: 1575-1586
[Full Text]