Lecture 06 - Cystic Fibrosis Flashcards

1
Q

What is cystic fibrosis

A

an autosomal recessive genetic disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a rare way to get CF

A

get 2 mutations from one parent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the effected gene in CF

A

CFTR on chromosome 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many amino acids are in the CFTR protein

A

1480

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the function of the CFTR protein

A

a chloride channel in the lungs, liver and GI systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common mutation

A

the F508 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percent of people with CF have the Class I mutation

A

22%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What percent of people with CF have the Class II mutation

A

88%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What percent of people with CF have the Class III mutation

A

6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What percent of people with CF have the Class IV mutation

A

6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What percent of people with CF have the Class V mutation

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What percent of people with CF have the Class VI mutation

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the presentation of a normal CFTR

A

CFTR protein is created and moves to the cell surface allowing the transfer of chloride and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the presentation of a Class I CFTR mutation

A

no functional CFTR protein is created

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the presentation of a Class II CFTR mutation

A

CFTR protein is created but misfolds keeping it from moving to the cell surface (traffic defect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the presentation of a Class III CFTR mutation

A

CFTR protein is created and moves to the cell surface but the channel gate does not open (defective regulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the presentation of a Class IV CFTR mutation

A

CFTR protein is created and moves to the cell surface but the channel is faulty (decreased channel conductance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the presentation of a Class V CFTR mutation

A

Normal CFTR protein is created and moves correctly to the cell surface but not enough protein is made (reduce synthesis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the presentation of a Class IV CFTR mutation

A

CFTR protein is created but it does not work properly at the cell membrane (decreased stability)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the F508 mutation

A

amino acid 508 is deleted which effects protein folding

21
Q

What parts of the body are most effected by CF

A

sinuses, lungs, liver, pancreas, vas deferens

22
Q

What is the gold standard test for diagnosing CF

A

the sweat chloride test

23
Q

What sweat chloride results are negative for CF

A

</=29 mmol/L

24
Q

What sweat chloride results are inconclusive for CF

A

30-59 mmol/L

25
Q

What sweat chloride results are diagnostic for CF

A

> /= 60 mmol/L

26
Q

What else is used to diagnose CF

A

CFTR genetic analysis and CFTR physiologic testing

27
Q

How are newborns in alberta screened for CF

A

immunoassay for immunoreactive trypsinogen

28
Q

Why is the newborn screen just a screen and not diagnostic

A

because people with only one mutation or other pancreatic issues can also have increased levels

29
Q

What is the method of the CF screen

A

a sandwich assay using europium

30
Q

How are cutoffs for the newborn screen determined

A

based on the population

31
Q

What are the cutoffs at the UofA hospital

A

> /= 60 ug/L sent for secondary testing

<53 ug/L not sent for secondary testing

between 53 and 59 ug/L are sent for secondary testing to ensure that no CF is missed

32
Q

What is the sweat chloride test

A

iontophoresis of pilocarpine to stimulate sweat productions which are collected into a coiled capillary tube that contains blue dye the concentration of Cl is then measured using coulometry

33
Q

What is CFTR genotyping

A

determines the CFTR DNA sequences and can be used to suggest severity of disease as well as determine which therapies could be beneficial

34
Q

What is the luminex CF X-tag genotype assay

A

a combination of allele specific PCR and flow cytometry

Polystyrene beads with different concentrations of dyes are used to identify
specific genotypes

Capture oligos specific to the 5’ end of one of the primers in the alleles
specific PCR are covalently bounded to the beads via a polyimide bonds to
carboxyl groups that coat the beads

35
Q

How does the luminex CF X-tag genotype assay work

A
  1. DNA extraction from EDTA blood sample
  2. Multiplex PCR (16 amplicons)
  3. SAP/Exo treatment to degrade unincorporated primers and
    nucleotide
  4. Allele specific PCR
  5. Hybridization to beads
  6. Reporter addition Streptavidin – Phycoerythrin
  7. Flow cytometry measurements
36
Q

What does exonuclease I do

A

degrade unincorporated primers

37
Q

What does Shrimp Alkaline Phosphatase do

A

destroy unincorporated dNTPs

38
Q

What is the reporter in CF genotype assay

A

phycoerythrin coupled with streptavidin

39
Q

What is Ivacafter

A

a treatment that increases the probability that the CFTR channel is open to increase chloride transportation (used for Class III mutations)

40
Q

What is Lumacaftor

A

a treatment that increased the stability of the p.Phe508del misfold protein allowing more proteins to be trafficked to the cell membrane (not effective alone)

41
Q

What is Tezacaftor

A

a corrector that improves cellular processing and trafficking of F508del CFTR

42
Q

What is Orkambi

A

a combination of lumacaftor and ivacaftor

43
Q

What is Symdeko

A

a combination of Texacaftor and Ivacaftor

44
Q

What is elexacaftor

A

a CFTR corrector and potentiator that stabilizes F508del CFTR

45
Q

What is trikafta

A

a combination of elexacaftr, tezacaftor and ivacaftor

46
Q

What is heterogeneity

A

CFTR protein activity = CFTR quantity X CFTR function

47
Q

What is a concern to take into consideration regarding Trikafta

A

it can cross the placenta at infant therapeutic levels meaning if the mom is on the drug then the baby may test false negative at NBS

48
Q

What can cause false positives in the chloride sweat test

A

improper testing technique
active smoking the day of the test
other medical conditions
specific medications