WINSTON-SALEM, N.C. – Researchers at Wake Forest University Baptist Medical Center, and colleagues, have identified a gene that modifies the severity of lung disease in people with cystic fibrosis, a lethal genetic condition. The findings open the door to possible new targets for treatment, researchers say.
The study appeared online last week in advance of print publication in Nature. It is the first published study to search the entire genome looking for genes that modify the severity of cystic fibrosis lung disease.
"This is a good example of researchers with different expertise coming together and using the knowledge gained from mapping the human genome to make discoveries that improve our understanding of cystic fibrosis," said Carl Langefeld, Ph.D., a study co-author and Wake Forest University School of Medicine researcher. "It may also help in the identification of targets for drug development and the development of tools for the earlier diagnosis of individuals with cystic fibrosis who are susceptible to severe lung disease."
After analyzing the genetic makeup of nearly 3,000 cystic fibrosis patients, researchers found that small genetic differences in a gene called IFRD1 correlate with lung disease severity. While probing how the gene might alter the disease's course, researchers discovered the protein encoded by IFRD1 is particularly abundant in a type of white blood cell called neutrophils, and that it regulates their function. Part of the immune system, neutrophils are known to cause inflammatory damage to the airways of people with cystic fibrosis.
"Neutrophils appear to be particularly bad actors in cystic fibrosis," said senior investigator Christopher Karp, M.D., the director of Molecular Immunology at Cincinnati Children's Hospital Medical Center. "They are important to the immune system's response to bacterial infection. In cystic fibrosis, however, neutrophilic airway inflammation is dysregulated, eventually destroying the lung."
Although it's been known for 20 years that cystic fibrosis is caused by mutations in the CFTR gene, the molecular mechanisms that link these mutations to the generation of lung disease still remain unclear. Increasingly evident in recent years is that variations in other genes also play a role in controlling cystic fibrosis lung disease severity.
Prior to the current study, IFRD1 was not really considered by researchers looking for genetic modifiers of disease severity, although the gene had been linked to stress responses in muscle and other tissues.
To further explore IFRD1's role in the disease process, the researchers studied mice in which the IFRD1 gene was removed. Deleting the gene confirmed its role in regulating inflammation and disease. While the absence resulted in delayed clearance of bacteria from the airway, it also resulted in less inflammation and disease.
The researchers also studied blood samples from healthy human volunteers to verify the impact of genetic differences in IFRD1 on neutrophil regulation. They found that the same IFRD1 variations that modified cystic fibrosis lung disease severity also altered neutrophil function in the healthy volunteers.
In a finding that may be the basis for novel approaches to treating cystic fibrosis, the investigators also determined that IFRD1's regulation of neutrophil function depends on its interaction with histone deacetylases – enzymes important for regulating gene transcription. Additional research is needed to better understand this interaction before its potential role for treatment is known, researchers report.
"It's possible that IFRD1 itself could become a target for treatment, but right now it's a signpost to pathways for further study," Karp said. "We want to find out what other genes and proteins IFRD1 interacts with, and how this is connected to inflammation in cystic fibrosis lung disease."
According to the National Cystic Fibrosis Foundation, cystic fibrosis is an inherited chronic disease that affects the lungs and digestive systems of about 30,000 children and adults in the United States and 70,000 worldwide. The defect in the CFTR gene causes the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections. It also obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food.
In the 1950s, few children with cystic fibrosis lived to attend elementary school. Today, advances in research and medical treatments have allowed people to live into their 30s or 40s. Despite these advances, the norm remains an ongoing decline in pulmonary function.
Funding support for the study came from the National Cystic Fibrosis Foundation, the National Heart Lung and Blood Institute, the Austrian Science Fund, and the Wake Forest University Health Sciences Center for Public Health Genomics.
Other institutions involved in the study include: the McKusick-Nathans Institute of Genetic Medicine and Department of Medicine at Johns Hopkins University School of Medicine, Baltimore; the Departments of Pediatrics and Genetics, Case Western Reserve University, Cleveland; the Cystic Fibrosis-Pulmonary Research and Treatment Center, University of North Carolina, Chapel Hill; Biocenter, Division of Cell Biology at Innsbruck Medical University, Innsbruck, Austria; Oklahoma Medical Research Foundation and JK Autoimmunity Inc., Oklahoma City, Okla.; The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, United Kingdom; and the Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University.
For interviews with researcher Carl D. Langefeld, Ph.D., of Wake Forest University Baptist Medical Center, contact Jessica Guenzel, jguenzel@wfubmc.edu, (336) 716-3487, or Bonnie Davis, bdavis@wfubmc.edu, (336) 716-4977.
For interviews with senior investigator Christopher Karp, M.D., of Cincinnati Children's Hospital Medical Center, contact Nick Miller (513) 803-6035.
Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.
Journal
Nature