Host and Bacterial Mechanisms During Cystic Fibrosis Pulmonary Exacerbations

N/AActive Not RecruitingNCT04354038

National Jewish Health100 enrolled

Overview

Cystic fibrosis pulmonary exacerbations (CF PEx) vary greatly in their severity, their pathogens, and their treatment responses. A failure to return to baseline lung function after treatment may be due to persistent infection or chronic inflammation or both. This constant infection and inflammation are believed to be tightly connected, making it difficult to know the exact reason why some patients fail to respond to treatment. The purpose of this study is to evaluate both infection and inflammation during CF PEx to allow for more personalized approaches to improve lung function responses and better CF PEx outcomes. Subjects will be asked to be in the study if they have CF, are 18 years of age or older, and are starting on IV antibiotics due to worsening lung infection. Subjects will stay in the study for up to 5 years, with visits occurring once a year if hospitalized for a CF PEx. Each visit will have blood, sputum, and urine collected and analyzed for changes in expression of certain genes and proteins. These changes may relate to improvements felt by people living with CF and determine what treatments are most helpful.

Study Type

OBSERVATIONAL

Enrollment

100

Conditions

Cystic Fibrosis

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * CF patients 18 years or older * hospitalized for IV treatment of an acute pulmonary exacerbation * not on investigational drugs * who can provide written consent and are willing to comply with study procedure Exclusion Criteria: • the presence of a condition or abnormality that, in the opinion of the Principal Investigator, would compromise the safety of the patient or the quality of the data.

Locations (1)

Outcomes

Primary Outcomes

Change between FEV1 and Th17/PD-1 expression during the course of treatment for pulmonary exacerbations using flow cytometry

There is a Th17 skewing association with a failure to return to baseline FEV1 values post pulmonary exacerbation, as measured using conventional flow cytometry followed by linear mixed effects models.

Time frame: Onset and end of CF pulmonary exacerbations, on average 10 days apart

Change between FEV1 and Th17/PD-1 expression over time using flow cytometry

Time frame: From initial CF pulmonary exacerbation to subsequent CF pulmonary exacerbation, assessed over a period of 60 months

Change in FEV1 and Th1/Th2/Th17 gene expression during the course of treatment for pulmonary exacerbations using single cell sequencing

Gene expression changes, with a particular emphasis on the relationship between changing cell composition (Th1, Th2, and Th17) single cell gene expression and FEV1 recovery, as measured by single cell sequencing of CD4+CD45RO+ memory cells, may be associated with a failure to return to baseline FEV1 during the course of treatment.

Time frame: Onset and end of CF pulmonary exacerbations, on average 10 days apart

Change in FEV1 and Th1/Th2/Th17 gene expression over time using single cell sequencing

Time frame: From initial CF pulmonary exacerbation to subsequent CF pulmonary exacerbation, assessed over a period of 60 months

Comparison of Th17 vs Th2 TCR repertoires during the course of treatment for pulmonary exacerbations through bulk TCR beta sequencing

Examining if an expanded clone within the Th17 lineage translates to greater inflammation and poorer FEV1 response during the course of treatment as measured by bulk TCR beta sequencing.

Time frame: Onset and end of CF pulmonary exacerbations, on average 10 days apart

Comparison of Th17 vs Th2 TCR repertoires over time through bulk TCR beta sequencing

Examining if an expanded clone within the Th17 lineage translates to greater inflammation and poorer FEV1 response over time as measured by bulk TCR beta sequencing.

Time frame: From initial CF pulmonary exacerbation to subsequent CF pulmonary exacerbation, assessed over a period of 60 months