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CFTR2 – Part 2Using CFTR2 to examine how CFTR mutations affect clinical outcome
Patrick Sosnay on behalf of the CFTR2 teamJohns Hopkins University
Perdana University Graduate School of Medicine
CFTR Mutations
Cystic Fibrosis
Genotype Phenotype
CFTR Mutations
Cystic Fibrosis
Pancreatic status differs by the type of mutation
Kristidis P, Bozon D, Corey M et al. Am J Hum Genet. 1992
Mutation Type
Example “severe”Pancreatic Insufficient
“mild”Pancreatic Sufficient
Missense G551D, R347H
Single amino acid deletion F508del
Stop Codon G542X Splice Junction 1717-1G>A
Frameshift 3659delC
Pancreatic status can be predicted from mutation class
Golgi
Rough endoplasmicreticulum
Nucleus
CFTR
I. RNA Expression
II. Folding and modification
IV. Channel function
V. Reduced expression
III. Channel activation
Welsh and Smith, Cell, 1993
PI
PS
Incomplete correlation between genotype and phenotype
• Good correlation with pancreatic status (insufficient vs. sufficient)
• Moderate correlation with sweat chloride concentration when patients are grouped according to pancreatic status
• Weak correlation with lung function
Individual mutations do not appear to correlate with lung function
0
20
40
60
80
100
F508del/F508del R117H/F508del
Pulmonary function
NS
The Cystic Fibrosis Genotype-Phenotype Consortium NEJM 1993
Discrete variable: Pancreatic sufficient or pancreatic insufficient
Mutations grouped by type or class
Specific GenotypeSpecific Genotype Specific Trait
Specific GenotypeSpecific Genotype Specific Trait
Continuous variable: Sweat chloride or lung function
Individual mutations ?
Clinical Data from CFTR2
1100 mutations in CFTR2
Continuous variable: Sweat chloride or lung function
Specific Trait
Use CFTR function measurements in cell lines as a way of describing genotypeSpecific GenotypeSpecific Genotype
020
4060
8010
012
0M
ean
Sw
eat
Chl
orid
e C
once
ntra
tion
0 50 100 150CFTR Function (Chloride Current as % of WT-CFTR)
CFTR chloride channel function correlates with sweat chloride concentration of patients that
carry the same mutations
M470V
I148T
R1070Q
020
4060
8010
012
0M
ean
Sw
eat
Chl
orid
e C
once
ntra
tion
0 50 100 150CFTR Function (Chloride Current as % of WT-CFTR)
CFTR chloride channel function correlates with sweat chloride concentration of patients that
carry the same mutations
The relationship between log10 CFTR function and sweat chloride is linear
020
4060
8010
012
0M
ean
Sw
eat
Chl
orid
e C
once
ntra
tion
0.1 1.0 10 100CFTR Function (log scale)
r=0.78, p<0.001
020
4060
8010
0M
ean
Lun
g F
unct
ion
(FE
V1%
pre
dict
ed)
0.1 1.0 10 100CFTR Function (log scale)
The relationship between log10 CFTR function and lung function is linear
r=0.56, p<0.001
Consequences of exponential relationship on lung function and sweat chloride concentration
020
4060
8010
0M
ean
Lun
g F
unct
ion
(FE
V1%
pre
dict
ed)
0.1 1.0 10 100CFTR Function (log scale)
020
4060
8010
012
0M
ean
Sw
eat
Chl
orid
e C
once
ntra
tion
0.1 1.0 10 100CFTR Function (log scale)
Mean sweat Chloride decreases 27 mEq/L (95% CI 20-33)
Mean lung function increases 8% predicted (95% CI 4-12)
0- 5% function
Consequence of exponential relationship on lung function and sweat chloride concentration
020
4060
8010
0M
ean
Lun
g F
unct
ion
(FE
V1%
pre
dict
ed)
0.1 1.0 10 100CFTR Function (log scale)
020
4060
8010
012
0M
ean
Sw
eat
Chl
orid
e C
once
ntra
tion
0.1 1.0 10 100CFTR Function (log scale)
Mean lung function increases 1.4% predicted (95% CI 0.7-2.1)
5- 10% function
Mean sweat chloride decreases 4.7 mEq/L (95% CI 3.6-5.8)
Why is there greater change in sweat chloride than in lung function with restoration of CFTR function?
• CFTR channel function plays a greater role in determining sweat chloride concentration than FEV1
Environment
Other genes
Opportunities for future studies• Collection of clinical data from patients in other
regions– To examine global variability– To inform disease liability of rare variants
• Correlate genotype with longitudinal measures of lung function and other complications of CF (e.g. lung infection)
• Examine the relationship of other CFTR functions (e.g. ENaC regulation, HCO3
- transport) with sweat chloride concentration, pancreatic status, and lung function
SummaryData from nearly 40,000 CF patients in the CFTR2
database has been instrumental in:
– Increasing the list of clinically, functionally and genetically vetted ‘CF-causing’ mutations from 23 to ~160 (more to follow..)
– Demonstrating that CFTR chloride channel function displays an exponential relationship with sweat chloride concentration and lung function.
– Revealing that improvement in low function CFTR mutations will have the greatest effect on CF phenotype.
With tremendous gratitudeCFTR2 Team:Michelle LewisKaren SiklosiJohanna RommensMary CoreyRuslan DorfmanJulian ZielenskiCarlo CastellaniFred Van GoorPhil Thomas, Margarida Amaral, Claude Ferec, Milan Macek, Phil FarrellAdi Gherman, Kyle Kaniecki, Jessica LaRusch, Darci Ferrer, Dave Masica, Kathleen Naughton, Neeraj Sharma
Chris PenlandPreston CampbellBruce MarshallLeslie HazleCindy GeorgeBob Beall
Mentors:Garry CuttingRachel KarchinCharlie Wiener
JHH CF Team: Michael Boyle, Noah Lechtzin, Christian Merlo, Meghan Ramsay, Sue Sullivan, Marsha Davis, Rebecca Smith, Karen VonBerg, Kathie Bukowski