How to be a Hermit in Flu Season – Top 10 Things to do to Avoid Winter Bugs

By: Beth Sufian

In the past month, many newspapers have reported that large numbers of people in the United States have fallen ill from widespread flu in every state except Hawaii.  People with CF are especially vulnerable to flu and other viruses that pop up in winter.  People spend more time indoors so it is easier for flu and viruses to spread.  I remember one of the first articles I read in CF Roundtable was by Joe Kowalski one of the founders of CF Roundtable.  He wrote about being a hermit during winter and how it reduced his incidence of getting sick.  I thought it was an interesting idea and after 18 years of doing a similar thing in winter, I thought I would share my strategies.

Here is a list of the top 10 things I do to try and reduce the likelihood of getting sick in winter. I know some people are already anxious about getting sick and this blog post is not meant to increase anxiety.  My hope is that one or more of these strategies may help some of you stay healthy during the winter.

Please share any effective strategies you use in the comments section below

1.Take Your Own Pen                                                                                                              On your next trip to the store watch as people take the pen at the checkout and sneeze or cough right on the pen. When you go to the store, doctor’s office or any other public place where you may need to sign something bring your own pen. It is easy to find pens with a stylus cap to use in stores that use a screen for signatures.

2. Take a Small Bottle of Hand Gel and a N-95 Mask                                                    If you find you have touched a surface that has been used by many like a door handle then make sure you have a bottle of hand sanitizer so that you can clean your hands.  In addition, keep a N-95 mask in your purse or backpack.  If you find yourself in a space with a person or many people who are coughing or sneezing you can quickly put on the mask.  If you feel self-conscious about wearing a mask just remember the last time you were sick and that should put those thoughts to the back of your mind.

3. Wear Gloves                                                                                                                        Wearing gloves can help you avoid germs when out in public.  While it is advised you should not shake hands with people this is a hard habit to break.  Wearing gloves allows you to shake hands and lower the risk of passing germs to yourself.  However, you need to make sure you wash the gloves frequently.

4. Step up your Treatments                                                                                               It is hard to avoid sick people if you work in an office or in a job that exposes you to the public so it is important to make sure you are doing your daily CF treatments.  In a perfect world, everyone with CF would do all the breathing treatments prescribed each day without missing any doses.  In reality, things get in the way.  Most people with CF tell me they normally skip a lot of treatments each week.  During winter it is important to reduce the number of missed treatments.  Medicine cannot work if it stays in the bottle.   People with CF often say “I do not have time to do my treatments”.  I think the opposite, I do not have time to get sick so I must make time to do my treatments.  If you are working in an office or going to school it is hard to avoid people who are sick but taking good care of yourself can reduce the chance of catching a winter bug.  Also, make sure you go for quarterly CF Care Center visits so that your CF Care team can monitor your health.

To make treatment time more enjoyable find something you really like to do and do it during treatment time.  If possible make that the main time you do the activity.  For example, if you like watching movies or playing video games make treatment time the time you watch movies or play games.  It takes discipline but can really help decrease missed treatments. Listening to music while doing treatments also helps to reduce the noise of the machines and can make treatment time relaxing.  Some people meditate while doing treatments and report it has a calming effect.

5. Avoid Crowds/ Avoid Sick Visitors                                                                             In the late 1990’s I was on and off IV’s many times due to illness.  I realized that often I finished a round of IV’s and would then go to a party or a big meeting and would be sick within 3 days.  When I started restricting my contact with sick people during winter and beyond my own incidence of illness decreased.  My close friends know they should cancel a lunch date with me if they think they may be sick or someone in their house is sick.  I still go out to lunch with friends but in winter I avoid big gatherings. For example, if my daughter’s school is having a meeting of parents I make sure I sit toward the front or back (depending on the room) on the side and not in the middle of the group.  But if I know the meeting will be in a small room with the potential of having a lot of people in attendance I send my husband to the meeting and stay home.

6. Exercise at Home                                                                                                           For me, going to a public gym or exercise class during winter makes me nervous.  I used to attend a yoga class that I enjoyed.  During the winter months half the class was sneezing and coughing and I decided that was not a good place for me to be exercising.  The same thing happened at a local gym.  Now I use yoga videos and step up the number of times I walk my dog.  I know in some places it is too cold to walk outside.  If you have to go to an indoor gym try to go at an off time.

7. Shop at Off Times                                                                                                      Once winter starts I become very disciplined about when I shop.  I love a certain grocery store in Houston that has beautiful food but it can be mobbed on the weekend and at lunchtime.  The other day I drove to the grocery store at 11 am but saw the parking lot was full.  I was tempted to just “run in” because I had driven there and needed a few things.  But I turned the car around and headed home.  I find that when the store first opens at 8 am there are very few shoppers so that is the best time for me to go.  If you work or go to school and this is not possible see if someone else can get things for you.   Some stores now have a way for you to order things online and then pick up the bagged items at the store. This fairly new service can be very helpful to people with CF.

8. No Airplane Travel                                                                                                         In the late 1990’s I was still traveling in winter. I would finish a course of IV’s and feel good and then a week later I would board an airplane and head to a work meeting, wedding or family event.  Within 3 days of returning from the trip, I would be sick and back on IV’s.  After 3 winters of this cycle of IV’s, travel and getting sick again I realized there was a direct correlation between my travel and getting sick.

My solution was to impose winter travel restrictions.  I do not fly on an airplane in January and February unless I need to travel for medical care.  This year I think I will extend my rule to mid- March given the widespread flu activity and what looks like extended cold weather in many places.  I have been restricting airplane travel since 2000 and have seen great results in terms of my health.  Also by having an absolute rule, no one feels slighted if I miss their wedding or event.  I do wear an N-95 mask when I fly on a plane in other months.  However, I found when I traveled in winter when I got to my destination (especially if the place had cold weather) I still got sick because I came into contact with a lot of sick people.

I travel a lot the rest of the year so having 2 months at home is a treat.  I just cleaned out 28 years of boxes that have accumulated in my attic.  February my goal is to clean and organize my closets.  In Houston where so many lost everything in Hurricane Harvey, it feels good to send things I do not use to those who need help.

9. Rest                                                                                                                                         I have come to the conclusion based on conversions with thousands of people with CF that people with CF do not enough sleep.  For those who work or go to school, there is always a shortage of time as a person tries to do breathing treatments in the morning and night and fit in work and school (or the other way around).  Those who are not attending work or school may find they have interrupted sleep due to coughing, low blood sugar or other health issues which results in exhaustion in the morning.  A decline in health also brings with it the need for more sleep. Sleep is extremely important and helps your body fight off viruses, the flu, and other bugs.  While it seems rare for most CF physicians to talk about the need for sleep it is very important and can really improve health and reduce the chance of getting sick.

10. Stay Connected                                                                                                               In Joe Kowalski’s day there was no Internet, Facebook or Twitter.  Talking on the phone was the way he stayed connected to friends and family during winter.  I make plans to speak to friends or to meet them for coffee or lunch when they feel well.  I also like to plan fun things to do in the spring and summer while I am in my winter cocoon.  I may have to pass up going to a party or an event in winter but I have found the reward of not being sick is worth it.  I look forward to reading of the strategies CF Roundtable Readers use to avoid winter bugs.

 

 

 

Low Level of Zinc Ions in Lungs Contribute to Buildup of Mucus in CF

When two channels that are supposed to move chloride and sodium ions out of cells in the lungs fail to function properly, it leads to the mucus buildup seen in cystic fibrosis.

Japanese researchers have discovered that the channel dysfunctions also reduce the amount of zinc ions going into the lungs, further contributing to the thick mucus accumulation.

Their study, published in the journal EBioMedicine, is titled “Zinc Deficiency via a Splice Switch in Zinc Importer ZIP2/SLC39A2 Causes Cystic Fibrosis-Associated MUC5AC Hypersecretion in Airway Epithelial Cells.Continue reading Low Level of Zinc Ions in Lungs Contribute to Buildup of Mucus in CF

Therapy for Reducing P. Aeruginosa Lung Infections Planned Phase 1 Trial

Arch Biopartners recently completed a good manufacturing practice (GMP) production campaign for AB569, a potential inhalation treatment for antibiotic-resistant bacterial lung infections in people with cystic fibrosis (CF) chronic obstructive pulmonary disease (COPD) and other conditions. The campaign, intended to ensure the quality of the investigative therapy, was directed by Dalton Pharma Services.

AB569 is composed of ethylenediaminetetraacetic acid (EDTA) and sodium nitrite, two compounds approved by the U.S. Food and Drug Administration (FDA) for use in people. AB569 can be administered alone or in combination with other compounds to treat multi-drug resistant bacterial infections that can cause reduced lung function.

Pseudomonas aeruginosa is one of the most common bacterial infections in patients with respiratory diseases, including CF, COPD, and pneumonia.

In preclinical studies, AB569 was shown to be capable of killing drug-resistant bacteria like P. aeruginosa and other common pathogens associated with chronic lung infections.

The company also announced that a Phase 1 clinical trial to investigate the safety and pharmacokinetic profile of AB569, planned to start in January, will be conducted at the Cincinnati Veterans Affairs Medical Center (CVAMC). According to an Arch Biopartners press release, Ralph Panos, chief of medicine at CVAMC, will lead the trial.

Three escalating doses of nebulized AB569 will be used to evaluate tolerance to the treatment in about 25 healthy volunteers. Each will be given a single administration of nebulized AB569  to characterize the pharmacokinetic profile of plasma nitrite and nitrate metabolites, exhaled nitric oxide, and circulating hemoglobin.

Pharmacokinetics studies how a drug is absorbed, distributed and metabolized in, and expelled by, the body.

Should the Phase 1 trial in volunteers be successful, Arch Biopartners plans to move its AB569 program into a Phase 2 trial to test its effectiveness in treating chronic P.aeruginosa infections in COPD patients.

AB569 received orphan drug status by the FDA in November 2015 as a potential treatment of P. aeruginosa lung infections in CF patients. Orphan drug status is given to investigative medicines intended for people with rare diseases to speed their development and testing.

Original article: https://cysticfibrosisnewstoday.com/2017/12/12/arch-biopartners-readies-ab569-potential-treatment-for-cf-copd-lung-infections-for-phase-1-trial/

A Breath of Fresh Air for Biotechs Working on Cystic Fibrosis Therapies

Researchers from the University of Zurich have determined the structure of a chloride channel, which could be a target for new drugs to treat cystic fibrosis.

Researchers at the University of Zurich have found a new target for future cystic fibrosis treatments. The study, published in Nature, has uncovered the structure of a protein that could help to correct the mechanism underlying the buildup of sticky mucus in patients’ lungs. This could give rise to a new wave of therapeutics for the condition, which at the moment lacks disease-modifying treatments.

Cystic fibrosis is a severe genetic disease affecting the lungs, for which there is currently no cure. It is caused by a malfunctioning chloride channel, CFTR, which prevents the secretion of chloride by cells, leading to the production of thick, sticky mucus in the lung. The condition affects around 70,000 people worldwide, who suffer from chronic infections and require daily physiotherapy.

However, one potential approach to treat cystic fibrosis is to activate the calcium-activated chloride channel, TMEM16A, as an alternative route for chloride efflux. As TMEM16A is located within the same epithelium as CFTR, its activation could rehydrate the mucus layer. The research group used cryo-electron microscopy to decipher the structure of TMEM16A, which is part of a protein family that facilitates the flow of negatively charged ions or lipids across the cell membrane.

The changes that occur in the lungs of cystic fibrosis patients.

TMEM16A is found in many of our organs, playing a key role in muscle contraction and pain perception, as well as in the lungs. It forms an hourglass-shaped protein-enclosed channel, which when bound by positively charged calcium ions, opens to let chloride ions to pass through the membrane.

Current treatments for cystic fibrosis include bronchodilators, mucus thinners, antibiotics, and physiotherapy, which only control symptoms. However, biotechs around Europe are beginning to make progress, with ProQR completing a Phase Ib trial and Galapagos and Abbvie’s triple combination therapy entering Phase I. Antabio has also received €7.6M from CARB-X to develop a new antibiotic against Pseudomonas infections.

The identification of a new target provides patients and biotechs alike with renewed hope of new and effective cystic fibrosis treatments, or even a cure. It will be interesting to see whether small molecules or gene therapy specialists could take advantage of this information.

Original article: https://labiotech.eu/cystic-fibrosis-treatment-target/

Cancer gene plays key role in cystic fibrosis lung infections

PTEN is best known as a tumor suppressor, a type of protein that protects cells from growing uncontrollably and becoming cancerous. But according to a new study from Columbia University Medical Center (CUMC), PTEN has a second, previously unknown talent: working with another protein, CFTR, it also keeps lung tissue free and clear of potentially dangerous infections.

The findings, published in Immunity, explain why people with cystic  are particularly prone to respiratory infections—and suggest a new approach to treatment.

A quarter-century ago, researchers discovered that cystic fibrosis is caused by mutations in the CFTR gene, which makes an eponymous protein that transports chloride ions in and out of the cell. Without ion transport, mucus in the lung becomes thicker and stickier and traps bacteria—especially Pseudomonas—in the lung. The trapped bacteria exacerbate the body’s inflammatory response, leading to persistent, debilitating infections.

But newer research suggests CFTR mutations also encourage infections through a completely different manner.

“Recent findings suggested that  with CFTR mutations have a weaker response to bacteria, reducing their ability to clear infections and augmenting inflammation,” said lead author Sebastián A. Riquelme, PhD, a postdoctoral fellow at CUMC. “This was interesting because it pointed to a parallel deregulated immune mechanism that contributes to airway destruction, beyond CFTR’s effect on mucus.”

That’s where PTEN comes into play. “We had no idea that PTEN was involved in cystic fibrosis,” said study leader Alice Prince, MD, professor of pediatrics (in pharmacology). “We were studying mice that lack a form of PTEN and noticed that they had a severe inflammatory response to Pseudomonas and diminished clearance that looked a lot like what we see in patients with cystic fibrosis.”

Delving deeper, the CUMC team discovered that when PTEN is located on the surface of lung and immune cells, it helps clear Pseudomonas bacteria and keeps the inflammatory response in check. But PTEN can do this only when it’s attached to CFTR.

And in most cases of cystic fibrosis, little CFTR finds it way to the cell surface. As a result, the duo fail to connect, and Pseudomonas run wild.

As it happens, the latest generation of cystic fibrosis drugs push mutated CFTR to the cell surface, with the aim of improving chloride channel function and reducing a buildup of mucus. The new findings suggest that it might be beneficial to coax nonfunctional CFTR to the surface as well, since even abnormal CFTR can work with PTEN to fight infections, according to the researchers.

“Another idea is to find drugs that improve PTEN membrane anti-inflammatory activity directly,” said Dr. Riquelme. “There are several PTEN promotors under investigation as cancer treatments that might prove useful in cystic fibrosis.”

The study also raises the possibility that PTEN might have something to do with the increased risk of gastrointestinal cancer in . “With better clinical care, these patients are living much longer, and we’re seeing a rise in gastrointestinal cancers,” said Dr. Prince. “Some studies suggest that CFTR may be a tumor suppressor. Our work offers an alternative hypothesis, where CFTR mutations and lack of its partner, PTEN, might be driving this cancer in patients with .”

The paper is titled, “Cystic fibrosis transmembrane conductance regulator attaches tumor suppressor PTEN to the membrane and promotes anti Pseudomonas aeruginosa immunity.”

For journal article click here:

http://www.cell.com/immunity/fulltext/S1074-7613(17)30487-9

New Promising Results from Phase 3 of Combination Therapy

Findings from a phase 3 trial evaluating the efficacy and safety of tezacaftor in combination with ivacaftor in patients with cystic fibrosis (CF) who were homozygous for the Phe508del mutation were published in the New England Journal of Medicine.

The Phe508del mutation has been known to result in greatly reduced conductance regulator (CFTR) protein activity and a loss of chloride secretion, which can lead to impaction of mucus in the airways, gastrointestinal tract, and exocrine organs, with the potential for severe clinical consequences including gradual loss of lung function, nutritional deficits, pulmonary exacerbations, and respiratory failure. It is the most prevalent CFTR mutation worldwide, and affects approximately 46% of American CF patients.

Previous data has shown Ivacaftor’s association with a rate of progressive decline in lung function that is lower than that in untreated patients. In a phase 2 clinical trial involving patients who were homozygous for the Phe508del mutation or heterozygous for the Phe508del and G551D mutations, when combined with the investigational CFTR corrector tezacaftor, it has exhibited enhanced CFTR function and improved lung function.

In August, just one month removed from Vertex’s announcement of positive datafrom Phase 1 and Phase 2 studies, Rare Disease Report covered the acceptance of applications for the use of the tezacaftor/ivacaftor combination treatment in this patient population by the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA).

The phase 3 trial enrolled a total of 510 patients 12 years and older with CF who were homozygous for the Phe508del CFTR mutation at 91 sites in the U.S., Canada, and Europe from January 30, 2015 to January 20, 2017. Patients were randomly assigned to be administered either tezacaftor and ivacaftor (administered as a fixed-dose combination tablet containing 100 mg of tezacaftor and 150 mg of ivacaftor in the morning and a tablet containing 150 mg of ivacaftor in the evening) combination therapy or placebo for 24 weeks.

In total, 475 patients completed the full 24 weeks of the trial, with 93.6% (n=235) in the tezacaftor-ivacaftor group and 93% (n=240) in the placebo group. While no significant difference in the body mass index (BMI) was experienced between the groups at week 24, the use of the combination therapy led to a significantly greater absolute change from baseline in the predicted forced expiratory volume in 1 second (FEV1) than placebo. Despite advances in standard-of-care therapy, patients with CF continue to lose lung function at a rate of an estimated 1% to 3% per year. This trial exhibited a significant effect of the combination therapy compared to the placebo, as the mean absolute change from baseline in FEV1 through week 24 was 3.4 percentage points in the former, compared to 0.6 in the latter.

The most common adverse events (AEs) among the enrolled patients included infective pulmonary exacerbation, cough, headache, nasopharyngitis, increased sputum production, pyrecia, hemoptysis, oropharyngeal pain, and fatigue. The incidence of AEs was similar in both the group for combination therapy and the placebo group, however, those treated with lumacaftor-ivacaftor in the phase 3 did not experience an increased incidence of respiratory events (33 patients [13.1%] vs. 41 patients [15.9%]).

This improved safety profile of the tezacaftor-ivacaftor combination supports its use in a broad range of patients with CF, and, if approved, the therapy will be the third of Vertex’s drugs approved for CF patients, and the second intended specifically to treat patients with F508del mutations (Orkami [lumacaftor/ivacaftor]).

For original article please visit: http://www.raredr.com/news/phase-3-combination-therapy-cystic-fibrosis?t=physicians

For the published study please visit: http://www.nejm.org/doi/full/10.1056/NEJMoa1709846?query=genetics#t=articleDiscussion

Home Spirometers: A Useful Tool in Tracking CF Symptoms and Progress

Guest Blog By: Meranda Honaker

Over the last several months my health has continued to decline despite being compliant and diligent with my healthcare routine. In July I developed a fever during a trip to Boston to speak to a biotech company about my journey with cystic fibrosis. I developed a fever and by the end of my visit, I was unable to walk up steps without severe dyspnea. I was so exhausted from feeling sick I would return to my hotel room to lay in the bed for hours to rest. My chest pain and shortness of breath became so severe in the coming days that I could no longer take a deep breath. I checked my SpiroPd home spirometer which displayed a definite decline in my lung function. I immediately contacted my CF clinic to see my CF doctor. Initially, despite feeling bad, I assumed I was feeling poorly and decided not to rush to CF clinic. Sometimes I have a bad day or few bad days health wise and begin to improve on my own. Once I saw my lung function had declined I knew I needed to be seen in CF clinic rather than waiting it out.
Continue reading Home Spirometers: A Useful Tool in Tracking CF Symptoms and Progress

News on new drug to treat B. Cepacia

https://cysticfibrosisnewstoday.com/2017/07/31/synspira-snsp113-may-be-game-changer-cf-cystic-fibrosis-drug-resistant-bacteria/

Originally published on Cystic Fibrosis Today Website 7/31/17
By Reid D’Amico

Synspira’s CF Therapy May Be Game-Changer for Drug-Resistant Bacteria

Chronic pulmonary infections are a hallmark of lung disease in patients with cystic fibrosis. Due to the variability in bacteria that can colonize the lung and Continue reading News on new drug to treat B. Cepacia

New Drug Improves Effectiveness of Antibiotics against Drug-resistant Bacteria

Synspira’s Novel Glycopolymer Improves Effectiveness of Antibiotics Against Drug-resistant Bacteria Associated with Cystic Fibrosis

Synspira, a privately held company developing a new class of inhaled glycopolymer-based therapeutics for the treatment of pulmonary disease, Continue reading New Drug Improves Effectiveness of Antibiotics against Drug-resistant Bacteria