Carlo Castellani - Academia.edu (original) (raw)

Papers by Carlo Castellani

Research paper thumbnail of 14 Updated survey of newborn screening for cystic fibrosis

Journal of Cystic Fibrosis, 2014

Research paper thumbnail of Genotypes and phenotypes in cystic fibrosis and cystic fibrosis transmembrane regulator-related disorders

Seminars in respiratory and critical care medicine, 2015

Cystic fibrosis (CF) is characterized by remarkable variability in severity, rate of disease prog... more Cystic fibrosis (CF) is characterized by remarkable variability in severity, rate of disease progression, and organ involvement. In spite of the considerable amount of data collected on the relationship between genotype and phenotype in CF, this is still a challenging matter of debate. Barriers to the interpretation of this connection are the large number of mutations in the CF transmembrane regulator (CFTR) gene, the difficulties in attributing several of them to a specific mode of dysfunction, and a limited number of the almost 2,000 mutations so far detected, which have been clinically annotated. In addition to that, the heterogeneity of clinical manifestations in individuals with the same CFTR genotypes indicates that disease severity is modulated by other genes and by environmental factors, of which the most relevant is possibly treatment in its aspects of appropriateness, early start in life, and adherence. The phenotype variability extends to conditions, named CFTR-related di...

Research paper thumbnail of Carrier screening for cystic fibrosis in the new era of medications that restore CFTR function

Research paper thumbnail of Emerging issues in cystic fibrosis newborn screening

Current opinion in pulmonary medicine, 2010

There has been a rise in the introduction of cystic fibrosis (CF) newborn screening (NBS) program... more There has been a rise in the introduction of cystic fibrosis (CF) newborn screening (NBS) programs in recent years. Despite many long running and successful programs with established protocols, new strategies are being developed in an effort to improve sensitivity and specificity. In light of the emerging issues of NBS, new algorithms have been implemented and are reviewed here. The increase in mixing of populations affects both immunoreactive trypsinogen values and sensitivity of genetic analysis in NBS. Adjustments to the mutation panel are not always possible. Algorithms adding nongenetic tiers may prove to be an alternative. The interpretation of the sweat test in neonates has been changing too, and there is now agreement that the upper limit of a normal sweat chloride is 29 mmol/l. Infants identified by NBS with a sweat chloride of 30-59 mmol/l and no evidence of two CF-causing mutations require further evaluation and often a long clinical follow-up before CF may be confirmed o...

Research paper thumbnail of Increased prevalence of mutations of the cystic fibrosis gene in idiopathic chronic and recurrent pancreatitis

The American journal of gastroenterology, 1999

Research paper thumbnail of Natural history of CFTR gene mutations associated pancreatitis

Research paper thumbnail of Benchmarks for Cystic Fibrosis carrier screening: A European consensus document

This paper presents an overview of the conclusions from an international conference convened to a... more This paper presents an overview of the conclusions from an international conference convened to address current issues related to the provision of Cystic Fibrosis carrier screening within Europe. Consensus was not aimed at stating whether such a programme should be implemented. Instead the focus was to provide a framework for countries and agencies who are considering or planning its establishment. The general principles and target population of Cystic Fibrosis carrier screening, advantages and disadvantages, health economics, monitoring and future evaluative and Journal of Cystic Fibrosis 9 (2010) 165 -178 www.elsevier.com/locate/jcf

Research paper thumbnail of Keratin 8 sequence variants in patients with pancreatitis and pancreatic cancer

Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered e... more Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered epithelia of the gastrointestinal tract. Transgenic mice over-expressing human KRT8 display pancreatic mononuclear infiltration, interstitial fibrosis and dysplasia of acinar cells resulting in exocrine pancreatic insufficiency. These experimental data are in accordance with a recent report describing an association between KRT8 variations and chronic pancreatitis. This prompted us to investigate KRT8 polymorphisms in patients with pancreatic disorders. The KRT8 Y54H and G62C polymorphisms were assessed in a cohort of patients with acute and chronic pancreatitis of various aetiologies or pancreatic cancer originating from Austria (n=16), the Czech Republic (n=90), Germany (n=1698), Great Britain (n=36), India (n=60), Italy (n=143), the Netherlands (n=128), Romania (n=3), Spain (n=133), and Switzerland (n=129). We also studied 4,234 control subjects from these countries and 1,492 control subjects originating from Benin, Cameroon, Ethiopia, Ecuador, and Turkey. Polymorphisms were analysed by melting curve analysis with fluorescence resonance energy transfer probes. The frequency of G62C did not differ between patients with acute or chronic pancreatitis, pancreatic adenocarcinoma and control individuals. The frequency of G62C varied in European The focus of his scientific work is chronic pancreatitis and inflammation-associated carcinogenesis of the pancreas as well as the influence of NF-κB on pancreatic fibrogenesis. populations from 0.4 to 3.8%, showing a northwest to southeast decline. The Y54H alteration was not detected in any of the 2,436 patients. Only 3/4,580 (0.07%) European, Turkish and Indian control subjects were heterozygous for Y54H in contrast to 34/951 (3.6%) control subjects of African descent. Our data suggest that the KRT8 alterations, Y54H and G62C, do not predispose patients to the development of pancreatitis or pancreatic cancer.

Research paper thumbnail of European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis

Journal of Cystic Fibrosis, 2014

Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades... more Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades, well above what was seen in the general population over the same period. With the implementation of newborn screening in many European countries, centres are increasingly caring for a cohort of patients who have minimal lung disease at diagnosis and therefore have the potential to enjoy an excellent quality of life and an even greater life expectancy than was seen previously. To allow high quality care to be delivered throughout Europe, a landmark document was published in 2005 that sets standards of care. Our current document builds on this work, setting standards for best practice in key aspects of CF care. The objective of our document is to give a broad overview of the standards expected for screening, diagnosis, pre-emptive treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support. For comprehensive details of clinical care of CF, references to the most up to date European Consensus Statements, Guidelines or Position Papers are provided in . We hope that this best practice document will be useful to clinical teams both in countries where CF care is developing and those with established CF centres.

Research paper thumbnail of Clinical expression of patients with the D1152H CFTR mutation

Journal of Cystic Fibrosis, 2015

Background: Discordant results were reported on the clinical expression of subjects bearing the D... more Background: Discordant results were reported on the clinical expression of subjects bearing the D1152H CFTR mutation, and also for the small number of cases reported so far. Methods: A retrospective review of clinical, genetic and biochemical data was performed from individuals homozygous or compound heterozygous for the D1152H mutation followed in 12 Italian cystic fibrosis (CF) centers. Results: 89 subjects carrying at least D1152H on one allele were identified. 7 homozygous patients had very mild clinical expression. Over half of the 74 subjects compound heterozygous for D1152H and a I-II-III class mutation had borderline or pathological sweat test and respiratory or gastrointestinal symptoms; one third had pulmonary bacteria colonization and 10/74 cases had complications (i.e. diabetes, allergic bronchopulmonary

Research paper thumbnail of Carrier Testing Program in a High-Risk Cystic Fibrosis Population from Northeastern Italy

Community Genetics, 1999

To assess the practicability and monitor the results of an active carrier testing program among r... more To assess the practicability and monitor the results of an active carrier testing program among relatives of cystic fibrosis (CF) patients. Parents of CF patients in the Veneto and Trentino regions of northeastern Italy were asked to help recruit relatives aged between 18 and 45 years for CF mutation testing. Of 409 enrolled CF parents, 59.6% agreed to send to the CF Center family composition data of relatives up to the third degree, and 28.8% recruited relatives to carrier testing, providing names and addresses of those who, being contacted, expressed a willingness to be tested. The participation of parents was higher if they were young and had a child recently diagnosed with CF. Recruiting parents indicated 333 close relatives (59%) for testing. When contacted by the CF Center, 170 of these 333 (51%) attended for testing. The percentage of close relatives who spontaneously asked for the test was 5.4% before the carrier testing program started; it rose to 25.3% following the introduction of the active strategy. The participation of the parents of CF patients is an important factor affecting the utilization of testing by relatives. Besides this, the influence of a favorable medical and cultural context (participation of gynecologists and family doctors in testing programs, genetic education of the general population) has to be considered.

Research paper thumbnail of A degradation-sensitive anionic trypsinogen (PRSS2) variant protects against chronic pancreatitis

Research paper thumbnail of Keratin 8 sequence variants in patients with pancreatitis and pancreatic cancer

Journal of Molecular Medicine, 2006

Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered e... more Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered epithelia of the gastrointestinal tract. Transgenic mice over-expressing human KRT8 display pancreatic mononuclear infiltration, interstitial fibrosis and dysplasia of acinar cells resulting in exocrine pancreatic insufficiency. These experimental data are in accordance with a recent report describing an association between KRT8 variations and chronic pancreatitis. This prompted us to investigate KRT8 polymorphisms in patients with pancreatic disorders. The KRT8 Y54H and G62C polymorphisms were assessed in a cohort of patients with acute and chronic pancreatitis of various aetiologies or pancreatic cancer originating from Austria (n=16), the Czech Republic (n=90), Germany (n=1698), Great Britain (n=36), India (n=60), Italy (n=143), the Netherlands (n=128), Romania (n=3), Spain (n=133), and Switzerland (n=129). We also studied 4,234 control subjects from these countries and 1,492 control subjects originating from Benin, Cameroon, Ethiopia, Ecuador, and Turkey. Polymorphisms were analysed by melting curve analysis with fluorescence resonance energy transfer probes. The frequency of G62C did not differ between patients with acute or chronic pancreatitis, pancreatic adenocarcinoma and control individuals. The frequency of G62C varied in European The focus of his scientific work is chronic pancreatitis and inflammation-associated carcinogenesis of the pancreas as well as the influence of NF-κB on pancreatic fibrogenesis. populations from 0.4 to 3.8%, showing a northwest to southeast decline. The Y54H alteration was not detected in any of the 2,436 patients. Only 3/4,580 (0.07%) European, Turkish and Indian control subjects were heterozygous for Y54H in contrast to 34/951 (3.6%) control subjects of African descent. Our data suggest that the KRT8 alterations, Y54H and G62C, do not predispose patients to the development of pancreatitis or pancreatic cancer.

Research paper thumbnail of Is there evidence for correct diagnosis in cystic fibrosis registries?

Journal of Cystic Fibrosis, 2014

Cystic fibrosis (CF) spans a wide spectrum. Therefore, benchmarking between registries implies co... more Cystic fibrosis (CF) spans a wide spectrum. Therefore, benchmarking between registries implies comparing similar cohorts. Explore patient characteristics in Belgian (B), French (F), German (G) and Dutch (NL) registries (total N=13,122) and determine whether they fulfill predefined diagnostic criteria. Using as case definition sweat chloride >60mmol/L or 2 CFTR mutations identified, CF diagnosis was not documented in 2.8, 5.7, 6.5 and 21.6% of subjects in the F, B, NL, and G registries. Restricting CFTR mutation interpretation to 124 CF causing mutations in CFTR2, these numbers rose to 10.5, 10.4, 14.5 and 24.3% respectively. Excluding these subjects impacted on outcomes. The impact differed between countries; the largest changes seen were a decrease in % adults from 51.9 to 47.8% in G, a decrease in % pancreas sufficiency from 17.0 to 13.0 in F, an increase in % homozygous for F508del from 55.3 to 63.7 in NL and a decrease of % with sweat chloride ≤60mmol/L from 8.4 to 1.1 in B. CF diagnosis is not documented in 10 to 24% of patients included in CF registries. Excluding these patients for analyses leads to significant changes in outcomes.

Research paper thumbnail of A survey of newborn screening for cystic fibrosis in Europe

Journal of Cystic Fibrosis, 2007

Background: Cystic fibrosis (CF) is a recessively inherited condition caused by mutation of the C... more Background: Cystic fibrosis (CF) is a recessively inherited condition caused by mutation of the CFTR gene. Newborn infants with CF have raised levels of immuno-reactive trypsinogen (IRT) in their serum. Measurement of IRT in the first week of life has enabled CF to be incorporated into existing newborn screening (NBS) blood spot protocols. However, IRT is not a specific test for CF and NBS therefore requires a further tier of tests to avoid unnecessary referral for diagnostic testing. Following identification of the CFTR gene, DNA analysis for common CF-associated mutations has been increasingly used as a second tier test. The aim of this study was to survey the current practice of CF NBS programmes in Europe. Method: A questionnaire was sent to 26 regional and national CF NBS programmes in Europe. Results: All programmes responded. The programmes varied in number of infants screened and in the protocols employed, ranging from sweat testing all infants with a raised first IRT to protocols with up to four tiers of testing. Three different assays for IRT were used; in the majority (24) this was a commercially available kit (Delfia™). A number of programmes employed a second IRT measurement in the 4th week of life (as the IRT is more specific at this point). Nineteen programmes used DNA analysis for common CFTR mutations on samples with a raised first IRT. Three programmes used a second IRT measurement on infants with just one recognised mutation to reduce the number of infants referred for sweat testing. Referral to clinical services was prompt and diagnosis was confirmed by sweat testing, even in infants with two recognised mutations in most programmes. Subsequent clinical pathways were less uniform. Multivariate analysis demonstrated a relationship between the age of diagnosis and the timing of the first IRT. More sweat tests were undertaken if the first IRT was earlier and the diagnosis was later. Conclusions: Annually these programmes screen approximately 1,600,000 newborns for CF and over 400 affected infants are recognised. The findings of this survey will guide the development of European evidence based guidelines and may help new regions or nations in the development and implementation of NBS for cystic fibrosis.

Research paper thumbnail of Benchmarks for Cystic Fibrosis carrier screening: A European consensus document

Journal of Cystic Fibrosis, 2010

This paper presents an overview of the conclusions from an international conference convened to a... more This paper presents an overview of the conclusions from an international conference convened to address current issues related to the provision of Cystic Fibrosis carrier screening within Europe. Consensus was not aimed at stating whether such a programme should be implemented. Instead the focus was to provide a framework for countries and agencies who are considering or planning its establishment. The general principles and target population of Cystic Fibrosis carrier screening, advantages and disadvantages, health economics, monitoring and future evaluative and Journal of Cystic Fibrosis 9 (2010) 165 -178 www.elsevier.com/locate/jcf

Research paper thumbnail of European best practice guidelines for cystic fibrosis neonatal screening

Journal of Cystic Fibrosis, 2009

There is wide agreement on the benefits of NBS for CF in terms of lowered disease severity, decre... more There is wide agreement on the benefits of NBS for CF in terms of lowered disease severity, decreased burden of care, and reduced costs. Risks are mainly associated with disclosure of carrier status and diagnostic uncertainty. When starting a NBS programme for CF it is important to take precautions in order to minimise avoidable risks and maximise benefits.

Research paper thumbnail of Analysis of the entire coding region of the cystic fibrosis transmembrane regulator gene in idiopathic pancreatitis

Human Mutation, 2001

Public Health, CF Project, law 548/93; Italian CNR Strategic Project for Biothechnology. Gomez Li... more Public Health, CF Project, law 548/93; Italian CNR Strategic Project for Biothechnology. Gomez Lira M. had a fellowship from the Cystic Fibrosis Center of Verona

Research paper thumbnail of Mutations in the amiloride-sensitive epithelial sodium channel in patients with cystic fibrosis-like disease

Research paper thumbnail of Analysis of the complete coding region of the CFTR gene in a cohort of CF patients from North-Eastern Italy: identification of 90% of the mutations

Human Genetics, 1995

A complete coding-region analysis on 225 cystic fibrosis (CF) chromosomes from a cohort that incl... more A complete coding-region analysis on 225 cystic fibrosis (CF) chromosomes from a cohort that includes all the affected subjects born in two North-Eastern Italian regions over eight years was performed. In a previous study, we identified mutations on 166/225 (73.8%) CF chromosomes after screening for 62 mutations. To characterise the remaining 59 CF chromosomes, we carried out automated direct DNA sequencing (exons 9 and 13), RNA single-strand conformation polymorphism (exons 1-8 and 10-12) and denaturing gradient gel electrophoresis (exons 14a-24) of the 27 exons and flanking regions of the CF transmembrane conductance regulator gene. We identified 22 mutations, four of which are novel, viz. 711+5G--~A, R709X, 3132delTG and 2790-2A---~G, and we characterised 90.2% (203/225) of the CF chromosomes. Taking advantage of the homogeneity of the sample, an evaluation of the most important clinical parameters, assessed at the age of 12 years, is presented. We confirm some previously reported genotype-phenotype correlations and we report a new nonsense mutation (R709X) associated with a pancreatic sufficient phenotype.

Research paper thumbnail of 14 Updated survey of newborn screening for cystic fibrosis

Journal of Cystic Fibrosis, 2014

Research paper thumbnail of Genotypes and phenotypes in cystic fibrosis and cystic fibrosis transmembrane regulator-related disorders

Seminars in respiratory and critical care medicine, 2015

Cystic fibrosis (CF) is characterized by remarkable variability in severity, rate of disease prog... more Cystic fibrosis (CF) is characterized by remarkable variability in severity, rate of disease progression, and organ involvement. In spite of the considerable amount of data collected on the relationship between genotype and phenotype in CF, this is still a challenging matter of debate. Barriers to the interpretation of this connection are the large number of mutations in the CF transmembrane regulator (CFTR) gene, the difficulties in attributing several of them to a specific mode of dysfunction, and a limited number of the almost 2,000 mutations so far detected, which have been clinically annotated. In addition to that, the heterogeneity of clinical manifestations in individuals with the same CFTR genotypes indicates that disease severity is modulated by other genes and by environmental factors, of which the most relevant is possibly treatment in its aspects of appropriateness, early start in life, and adherence. The phenotype variability extends to conditions, named CFTR-related di...

Research paper thumbnail of Carrier screening for cystic fibrosis in the new era of medications that restore CFTR function

Research paper thumbnail of Emerging issues in cystic fibrosis newborn screening

Current opinion in pulmonary medicine, 2010

There has been a rise in the introduction of cystic fibrosis (CF) newborn screening (NBS) program... more There has been a rise in the introduction of cystic fibrosis (CF) newborn screening (NBS) programs in recent years. Despite many long running and successful programs with established protocols, new strategies are being developed in an effort to improve sensitivity and specificity. In light of the emerging issues of NBS, new algorithms have been implemented and are reviewed here. The increase in mixing of populations affects both immunoreactive trypsinogen values and sensitivity of genetic analysis in NBS. Adjustments to the mutation panel are not always possible. Algorithms adding nongenetic tiers may prove to be an alternative. The interpretation of the sweat test in neonates has been changing too, and there is now agreement that the upper limit of a normal sweat chloride is 29 mmol/l. Infants identified by NBS with a sweat chloride of 30-59 mmol/l and no evidence of two CF-causing mutations require further evaluation and often a long clinical follow-up before CF may be confirmed o...

Research paper thumbnail of Increased prevalence of mutations of the cystic fibrosis gene in idiopathic chronic and recurrent pancreatitis

The American journal of gastroenterology, 1999

Research paper thumbnail of Natural history of CFTR gene mutations associated pancreatitis

Research paper thumbnail of Benchmarks for Cystic Fibrosis carrier screening: A European consensus document

This paper presents an overview of the conclusions from an international conference convened to a... more This paper presents an overview of the conclusions from an international conference convened to address current issues related to the provision of Cystic Fibrosis carrier screening within Europe. Consensus was not aimed at stating whether such a programme should be implemented. Instead the focus was to provide a framework for countries and agencies who are considering or planning its establishment. The general principles and target population of Cystic Fibrosis carrier screening, advantages and disadvantages, health economics, monitoring and future evaluative and Journal of Cystic Fibrosis 9 (2010) 165 -178 www.elsevier.com/locate/jcf

Research paper thumbnail of Keratin 8 sequence variants in patients with pancreatitis and pancreatic cancer

Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered e... more Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered epithelia of the gastrointestinal tract. Transgenic mice over-expressing human KRT8 display pancreatic mononuclear infiltration, interstitial fibrosis and dysplasia of acinar cells resulting in exocrine pancreatic insufficiency. These experimental data are in accordance with a recent report describing an association between KRT8 variations and chronic pancreatitis. This prompted us to investigate KRT8 polymorphisms in patients with pancreatic disorders. The KRT8 Y54H and G62C polymorphisms were assessed in a cohort of patients with acute and chronic pancreatitis of various aetiologies or pancreatic cancer originating from Austria (n=16), the Czech Republic (n=90), Germany (n=1698), Great Britain (n=36), India (n=60), Italy (n=143), the Netherlands (n=128), Romania (n=3), Spain (n=133), and Switzerland (n=129). We also studied 4,234 control subjects from these countries and 1,492 control subjects originating from Benin, Cameroon, Ethiopia, Ecuador, and Turkey. Polymorphisms were analysed by melting curve analysis with fluorescence resonance energy transfer probes. The frequency of G62C did not differ between patients with acute or chronic pancreatitis, pancreatic adenocarcinoma and control individuals. The frequency of G62C varied in European The focus of his scientific work is chronic pancreatitis and inflammation-associated carcinogenesis of the pancreas as well as the influence of NF-κB on pancreatic fibrogenesis. populations from 0.4 to 3.8%, showing a northwest to southeast decline. The Y54H alteration was not detected in any of the 2,436 patients. Only 3/4,580 (0.07%) European, Turkish and Indian control subjects were heterozygous for Y54H in contrast to 34/951 (3.6%) control subjects of African descent. Our data suggest that the KRT8 alterations, Y54H and G62C, do not predispose patients to the development of pancreatitis or pancreatic cancer.

Research paper thumbnail of European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis

Journal of Cystic Fibrosis, 2014

Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades... more Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades, well above what was seen in the general population over the same period. With the implementation of newborn screening in many European countries, centres are increasingly caring for a cohort of patients who have minimal lung disease at diagnosis and therefore have the potential to enjoy an excellent quality of life and an even greater life expectancy than was seen previously. To allow high quality care to be delivered throughout Europe, a landmark document was published in 2005 that sets standards of care. Our current document builds on this work, setting standards for best practice in key aspects of CF care. The objective of our document is to give a broad overview of the standards expected for screening, diagnosis, pre-emptive treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support. For comprehensive details of clinical care of CF, references to the most up to date European Consensus Statements, Guidelines or Position Papers are provided in . We hope that this best practice document will be useful to clinical teams both in countries where CF care is developing and those with established CF centres.

Research paper thumbnail of Clinical expression of patients with the D1152H CFTR mutation

Journal of Cystic Fibrosis, 2015

Background: Discordant results were reported on the clinical expression of subjects bearing the D... more Background: Discordant results were reported on the clinical expression of subjects bearing the D1152H CFTR mutation, and also for the small number of cases reported so far. Methods: A retrospective review of clinical, genetic and biochemical data was performed from individuals homozygous or compound heterozygous for the D1152H mutation followed in 12 Italian cystic fibrosis (CF) centers. Results: 89 subjects carrying at least D1152H on one allele were identified. 7 homozygous patients had very mild clinical expression. Over half of the 74 subjects compound heterozygous for D1152H and a I-II-III class mutation had borderline or pathological sweat test and respiratory or gastrointestinal symptoms; one third had pulmonary bacteria colonization and 10/74 cases had complications (i.e. diabetes, allergic bronchopulmonary

Research paper thumbnail of Carrier Testing Program in a High-Risk Cystic Fibrosis Population from Northeastern Italy

Community Genetics, 1999

To assess the practicability and monitor the results of an active carrier testing program among r... more To assess the practicability and monitor the results of an active carrier testing program among relatives of cystic fibrosis (CF) patients. Parents of CF patients in the Veneto and Trentino regions of northeastern Italy were asked to help recruit relatives aged between 18 and 45 years for CF mutation testing. Of 409 enrolled CF parents, 59.6% agreed to send to the CF Center family composition data of relatives up to the third degree, and 28.8% recruited relatives to carrier testing, providing names and addresses of those who, being contacted, expressed a willingness to be tested. The participation of parents was higher if they were young and had a child recently diagnosed with CF. Recruiting parents indicated 333 close relatives (59%) for testing. When contacted by the CF Center, 170 of these 333 (51%) attended for testing. The percentage of close relatives who spontaneously asked for the test was 5.4% before the carrier testing program started; it rose to 25.3% following the introduction of the active strategy. The participation of the parents of CF patients is an important factor affecting the utilization of testing by relatives. Besides this, the influence of a favorable medical and cultural context (participation of gynecologists and family doctors in testing programs, genetic education of the general population) has to be considered.

Research paper thumbnail of A degradation-sensitive anionic trypsinogen (PRSS2) variant protects against chronic pancreatitis

Research paper thumbnail of Keratin 8 sequence variants in patients with pancreatitis and pancreatic cancer

Journal of Molecular Medicine, 2006

Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered e... more Keratin 8 (KRT8) is one of the major intermediate filament proteins expressed in single-layered epithelia of the gastrointestinal tract. Transgenic mice over-expressing human KRT8 display pancreatic mononuclear infiltration, interstitial fibrosis and dysplasia of acinar cells resulting in exocrine pancreatic insufficiency. These experimental data are in accordance with a recent report describing an association between KRT8 variations and chronic pancreatitis. This prompted us to investigate KRT8 polymorphisms in patients with pancreatic disorders. The KRT8 Y54H and G62C polymorphisms were assessed in a cohort of patients with acute and chronic pancreatitis of various aetiologies or pancreatic cancer originating from Austria (n=16), the Czech Republic (n=90), Germany (n=1698), Great Britain (n=36), India (n=60), Italy (n=143), the Netherlands (n=128), Romania (n=3), Spain (n=133), and Switzerland (n=129). We also studied 4,234 control subjects from these countries and 1,492 control subjects originating from Benin, Cameroon, Ethiopia, Ecuador, and Turkey. Polymorphisms were analysed by melting curve analysis with fluorescence resonance energy transfer probes. The frequency of G62C did not differ between patients with acute or chronic pancreatitis, pancreatic adenocarcinoma and control individuals. The frequency of G62C varied in European The focus of his scientific work is chronic pancreatitis and inflammation-associated carcinogenesis of the pancreas as well as the influence of NF-κB on pancreatic fibrogenesis. populations from 0.4 to 3.8%, showing a northwest to southeast decline. The Y54H alteration was not detected in any of the 2,436 patients. Only 3/4,580 (0.07%) European, Turkish and Indian control subjects were heterozygous for Y54H in contrast to 34/951 (3.6%) control subjects of African descent. Our data suggest that the KRT8 alterations, Y54H and G62C, do not predispose patients to the development of pancreatitis or pancreatic cancer.

Research paper thumbnail of Is there evidence for correct diagnosis in cystic fibrosis registries?

Journal of Cystic Fibrosis, 2014

Cystic fibrosis (CF) spans a wide spectrum. Therefore, benchmarking between registries implies co... more Cystic fibrosis (CF) spans a wide spectrum. Therefore, benchmarking between registries implies comparing similar cohorts. Explore patient characteristics in Belgian (B), French (F), German (G) and Dutch (NL) registries (total N=13,122) and determine whether they fulfill predefined diagnostic criteria. Using as case definition sweat chloride >60mmol/L or 2 CFTR mutations identified, CF diagnosis was not documented in 2.8, 5.7, 6.5 and 21.6% of subjects in the F, B, NL, and G registries. Restricting CFTR mutation interpretation to 124 CF causing mutations in CFTR2, these numbers rose to 10.5, 10.4, 14.5 and 24.3% respectively. Excluding these subjects impacted on outcomes. The impact differed between countries; the largest changes seen were a decrease in % adults from 51.9 to 47.8% in G, a decrease in % pancreas sufficiency from 17.0 to 13.0 in F, an increase in % homozygous for F508del from 55.3 to 63.7 in NL and a decrease of % with sweat chloride ≤60mmol/L from 8.4 to 1.1 in B. CF diagnosis is not documented in 10 to 24% of patients included in CF registries. Excluding these patients for analyses leads to significant changes in outcomes.

Research paper thumbnail of A survey of newborn screening for cystic fibrosis in Europe

Journal of Cystic Fibrosis, 2007

Background: Cystic fibrosis (CF) is a recessively inherited condition caused by mutation of the C... more Background: Cystic fibrosis (CF) is a recessively inherited condition caused by mutation of the CFTR gene. Newborn infants with CF have raised levels of immuno-reactive trypsinogen (IRT) in their serum. Measurement of IRT in the first week of life has enabled CF to be incorporated into existing newborn screening (NBS) blood spot protocols. However, IRT is not a specific test for CF and NBS therefore requires a further tier of tests to avoid unnecessary referral for diagnostic testing. Following identification of the CFTR gene, DNA analysis for common CF-associated mutations has been increasingly used as a second tier test. The aim of this study was to survey the current practice of CF NBS programmes in Europe. Method: A questionnaire was sent to 26 regional and national CF NBS programmes in Europe. Results: All programmes responded. The programmes varied in number of infants screened and in the protocols employed, ranging from sweat testing all infants with a raised first IRT to protocols with up to four tiers of testing. Three different assays for IRT were used; in the majority (24) this was a commercially available kit (Delfia™). A number of programmes employed a second IRT measurement in the 4th week of life (as the IRT is more specific at this point). Nineteen programmes used DNA analysis for common CFTR mutations on samples with a raised first IRT. Three programmes used a second IRT measurement on infants with just one recognised mutation to reduce the number of infants referred for sweat testing. Referral to clinical services was prompt and diagnosis was confirmed by sweat testing, even in infants with two recognised mutations in most programmes. Subsequent clinical pathways were less uniform. Multivariate analysis demonstrated a relationship between the age of diagnosis and the timing of the first IRT. More sweat tests were undertaken if the first IRT was earlier and the diagnosis was later. Conclusions: Annually these programmes screen approximately 1,600,000 newborns for CF and over 400 affected infants are recognised. The findings of this survey will guide the development of European evidence based guidelines and may help new regions or nations in the development and implementation of NBS for cystic fibrosis.

Research paper thumbnail of Benchmarks for Cystic Fibrosis carrier screening: A European consensus document

Journal of Cystic Fibrosis, 2010

This paper presents an overview of the conclusions from an international conference convened to a... more This paper presents an overview of the conclusions from an international conference convened to address current issues related to the provision of Cystic Fibrosis carrier screening within Europe. Consensus was not aimed at stating whether such a programme should be implemented. Instead the focus was to provide a framework for countries and agencies who are considering or planning its establishment. The general principles and target population of Cystic Fibrosis carrier screening, advantages and disadvantages, health economics, monitoring and future evaluative and Journal of Cystic Fibrosis 9 (2010) 165 -178 www.elsevier.com/locate/jcf

Research paper thumbnail of European best practice guidelines for cystic fibrosis neonatal screening

Journal of Cystic Fibrosis, 2009

There is wide agreement on the benefits of NBS for CF in terms of lowered disease severity, decre... more There is wide agreement on the benefits of NBS for CF in terms of lowered disease severity, decreased burden of care, and reduced costs. Risks are mainly associated with disclosure of carrier status and diagnostic uncertainty. When starting a NBS programme for CF it is important to take precautions in order to minimise avoidable risks and maximise benefits.

Research paper thumbnail of Analysis of the entire coding region of the cystic fibrosis transmembrane regulator gene in idiopathic pancreatitis

Human Mutation, 2001

Public Health, CF Project, law 548/93; Italian CNR Strategic Project for Biothechnology. Gomez Li... more Public Health, CF Project, law 548/93; Italian CNR Strategic Project for Biothechnology. Gomez Lira M. had a fellowship from the Cystic Fibrosis Center of Verona

Research paper thumbnail of Mutations in the amiloride-sensitive epithelial sodium channel in patients with cystic fibrosis-like disease

Research paper thumbnail of Analysis of the complete coding region of the CFTR gene in a cohort of CF patients from North-Eastern Italy: identification of 90% of the mutations

Human Genetics, 1995

A complete coding-region analysis on 225 cystic fibrosis (CF) chromosomes from a cohort that incl... more A complete coding-region analysis on 225 cystic fibrosis (CF) chromosomes from a cohort that includes all the affected subjects born in two North-Eastern Italian regions over eight years was performed. In a previous study, we identified mutations on 166/225 (73.8%) CF chromosomes after screening for 62 mutations. To characterise the remaining 59 CF chromosomes, we carried out automated direct DNA sequencing (exons 9 and 13), RNA single-strand conformation polymorphism (exons 1-8 and 10-12) and denaturing gradient gel electrophoresis (exons 14a-24) of the 27 exons and flanking regions of the CF transmembrane conductance regulator gene. We identified 22 mutations, four of which are novel, viz. 711+5G--~A, R709X, 3132delTG and 2790-2A---~G, and we characterised 90.2% (203/225) of the CF chromosomes. Taking advantage of the homogeneity of the sample, an evaluation of the most important clinical parameters, assessed at the age of 12 years, is presented. We confirm some previously reported genotype-phenotype correlations and we report a new nonsense mutation (R709X) associated with a pancreatic sufficient phenotype.