Effects of Lumacaftor-Ivacaftor on Lung Clearance Index, Magnetic Resonance Imaging, and Airway Microbiome in Phe508del Homozygous Patients with Cystic Fibrosis.

Simon Y. Graeber, Sébastien Boutin, Mark O. Wielpütz, Cornelia Joachim, Dario L. Frey, Sabine Wege, Olaf Sommerburg, Hans-Ulrich Kauczor, Mirjam Stahl, Alexander H. Dalpke, Marcus A. Mall

Abstract

Rationale: Previous studies showed that lumacaftor-ivacaftor therapy results in partial rescue of CFTR (cystic fibrosis [CF] transmembrane conductance regulator) activity and a moderate improvement of spirometry in Phe508del homozygous patients with CF. However, the effects of lumacaftor-ivacaftor on lung clearance index (LCI), lung morphology and perfusion detected by chest magnetic resonance imaging (MRI), and effects on the airway microbiome and inflammation remain unknown. Objectives: To investigate the effects of lumacaftor-ivacaftor on LCI, lung MRI scores, and airway microbiome and inflammation. Methods: In this prospective observational study we assessed clinical outcomes including spirometry and body mass index, LCI, lung MRI scores, sputum microbiome, and proinflammatory cytokines in 30 Phe508del homozygous patients with CF 12 years and older before and 8-16 weeks after initiation of lumacaftor-ivacaftor therapy. Results: Lumacaftor-ivacaftor had no effects on forced expiratory volume in 1 second (FEV(1) (1.7 95CI], -1.0.3 P = 0.211) but improved LCI (-1.6; 95 -2.6 to -0.5; P textless 0.01) and MRI morphology (-1.3; 95 -2.3 to -0.3; P textless 0.05) and perfusion score (-1.2; 95 -2.3 to -0.2; P textless 0.05) in our study cohort. Furthermore, lumacaftor-ivacaftor decreased the total bacterial load (-1.8; 95 -3.3 to -0.34; P textless 0.05) and increased the Shannon diversity of the airway microbiome (0.4; 95 0.1 to 0.8; P textless 0.05), and reduced IL-1β (interleukin-1β) concentration (median change, -324.2 pg/ml; 95 -938.7 to 290.4 pg/ml; P textless 0.05) in sputum of Phe508del homozygous patients. Conclusions: This study shows that lumacaftor-ivacaftor has beneficial effects on lung ventilation, morphology, and perfusion, as well as on the airway microbiome and inflammation in Phe508del homozygous patients. Our results suggest that LCI and MRI may be more sensitive than FEV(1)NCT02807415).
OriginalspracheEnglisch
ZeitschriftAnnals of the American Thoracic Society
Jahrgang18
Ausgabenummer6
Seiten (von - bis)971-980
Seitenumfang10
ISSN2325-6621
DOIs
PublikationsstatusVeröffentlicht - 01.06.2021

Strategische Forschungsbereiche und Zentren

  • Forschungsschwerpunkt: Infektion und Entzündung - Zentrum für Infektions- und Entzündungsforschung Lübeck (ZIEL)
  • Forschungsschwerpunkt: Biomedizintechnik

DFG-Fachsystematik

  • 204-03 Medizinische Mikrobiologie und Mykologie, Hygiene, Molekulare Infektionsbiologie
  • 204-05 Immunologie
  • 205-32 Medizinische Physik, Biomedizinische Technik

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