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Medical reversal of chronic sinusitis in a cystic fibrosis patient with ivacaftor
Author(s) -
Chang Eugene H.,
Tang Xiao Xiao,
Shah Viral S.,
Launspach Janice L.,
Ernst Sarah E.,
Hilkin Brieanna,
Karp Philip H.,
Abou Alaiwa Mahmoud H.,
Graham Scott M.,
Hornick Douglas B.,
Welsh Michael J.,
Stoltz David A.,
Zabner Joseph
Publication year - 2015
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21440
Subject(s) - ivacaftor , medicine , cystic fibrosis , chronic sinusitis , sinusitis , cystic fibrosis transmembrane conductance regulator , sinus (botany) , mucociliary clearance , airway , gastroenterology , pathology , surgery , botany , lung , biology , genus
Background Chronic sinusitis is universal in cystic fibrosis (CF) and our current treatments are ineffective in reversing sinus disease. The objective of this work was to determine if increasing CF transmembrane conductance regulator (CFTR) activity by ivacaftor could treat CF sinus disease and assess its effect on primary sinus epithelial cultures. Methods Case report of 1 patient with long‐standing chronic sinus disease and a new diagnosis of CF with a mild mutation (P205S) and a severe mutation (G551D). We discuss clinical changes in symptoms, radiographic findings, nasal potential difference testing, and nasal pH values before and after treatment with ivacaftor. We then developed primary sinonasal epithelial cell cultures from a biopsy of the patient to determine changes in airway surface liquid (ASL) pH and ASL viscosity after ivacaftor treatment. Results Ivacaftor treatment reversed CT findings of CF sinus disease, increased nasal voltage and pH, and resolved sinus symptoms after 10 months of therapy. Ivacaftor significantly increased ASL pH and decreased ASL viscosity in primary airway cultures. Conclusion This report documents the reversal of CF sinus disease. Based on our in vivo and in vitro results, we speculate that ivacaftor may reverse CF sinusitis by increasing ASL pH and decreasing ASL viscosity. These studies suggest that CFTR modulation may be effective in treating CF and perhaps non‐CF sinusitis.