Lives unaffected by cystic fibrosis

Current Research

On this page:

 

Ann Maree Bosch Career Fellowship 2017

Project Title: RNA-based therapeutics for mutation-independent CF therapy

Name: Sharon Wong

Institution: School of Women’s and Children’s Health & University of NSW (UNSW)

Value: $10,000

Duration: 1 Year

Summary: Cystic fibrosis (CF) is caused by mutations of the CFTR gene which results in dysregulated salt and fluid transport in the body. There has been significant progress in CF therapy in the last 25 years; the average life expectancy of CF patients are now at ~38 years compared to 12 years when the gene was first discovered. Indeed, medications currently approved for CF patients, Kalydeco® and Orkambi® significantly improve symptoms and quality of life of CF patients, although they are only effective for patients with certain mutations eg. G551D and heterozygous DF508. Treatment option for patients with other CFTR mutations or perhaps one that works for all CF patients indiscriminately is still lacking.

The goal of this project is to develop an effective treatment for the general CF population, irrespective of their mutation types. We first establish a personalized and predictive platform for testing potential drugs in our lab by using patient-derived tissue specimens. Miniaturized versions of each CF patient are created using their own stem cells from lung and gut tissue, called the “CF AVATAR”, which swells up when a potential new drug restores the defective function of the CFTR protein. Notably, a recent study showed the reduction or absence of a novel human gene called BGas was shown to boost CFTR levels independent of CFTR mutation types. We will thus explore the therapeutic potential of a few small molecules targeting BGas in the patient-derived “CF AVATAR”. If successful, gene targeting will herald a new dawn in CF therapy, with one drug that works wonders across the entire CF population 

Reports: None to date (not due)

Back to top>

Innovation Grant 2018

Project Title: Detailed characterisation of structure-function relationships in mild cystic fibrosis lung disease and validation of an ultra low dose high resolution CT (HRCT) scanning protocol

Name: Paul Robinson

Institution: Children's Hospital Westmead, NSW

Value: $80,000

Duration: 1- year 

Summary:  Cystic Fibrosis (CF) is a life limiting condition causing mucus build up and infection within the lungs, ultimately resulting in death due to respiratory failure.

One approach to improve survival focuses on the accurate detection of early CF lung disease to facilitate earlier treatment intervention. Traditional tools have limitations in this setting, but newer techniques exist which are more sensitive, such as Multiple Breath Washout (MBW) and CT scanning.

However, the optimal way to use them remains unclear and the radiation associated with CT scanning remains a concern for CF physicians. This work uses advanced analysis approaches to improve our understanding of the changes that occur in early CF lung disease during childhood.

We will describe how the detailed information gained from these tests can be better used to detect early disease, and investigate the utility of ultra low dose CT scanning approaches in this setting to alleviate radiation concerns. Our assembled research team, with international expertise across these techniques is ideally positioned to carry out this work.

The results of study will provide vital help in early detection of CF lung disease, enhancing our ability for early treatment intervention and improved outcomes.

Reports: None Due

Back to top>

Innovation Grant 2017

Project Title: Investigating the role and therapeutic targeting of iron in cystic fibrosis

Name: Jay Horvat

Institution: University of Newcastle, NSW

Value: $80,000

Duration: 1-year 

Summary: Whilst improved therapeutic strategies have become available for CF, many patients still frequently experience exacerbations of disease that result in progressively increasing lung pathology and deteriorating lung function.

Infections play an important role in this progression of CF with persistent Pseudomonas infections a major contributor to CF morbidity and mortality. More effective strategies are desperately needed to improve efficacy for the treatment of Pseudomonas infection in CF in order to improve patient outcomes.

Studies have shown that iron levels are increased in the airways of CF patients and increased iron stimulates Pseudomonas biofilm formation, aggregation, adhesion and invasion, allowing the pathogen to avoid host removal. Indeed, in clinically stable CF patients, there is a strong positive correlation between sputum iron and Pseudomonas levels. These findings suggest that increased iron in CF patients is a potential causal factor of Pseudomonas persistence.

In this new study, we will use a novel combination of experimental models of increased iron loading in the lung and Pseudomonas infection and clinical investigations to better understand the role of iron in the pathogenesis of CF. We will also determine whether therapeutically suppressing increased iron levels in the airways improves the clearance of Pseudomonas infection from the lungs

Back to top>

Innovation Grant 2017

Title: RNA therapeutics: novel paradigm in mutation independent CF therapy

Name: Shafagh Waters

Institution: University of NSW (UNSW)

Value: $ 70,000

Duration: 1 year

Summary: Cystic fibrosis (CF) is a genetic disease, most common among people of European ancestry, afflicting ~70,000 individuals worldwide. It is caused by defects in a single gene that codes for the CF Transmembrane Regulator (CFTR) protein. Historically, therapies were restricted to treatment of symptoms, but new molecular therapies that restore function to the defective CFTR protein have been developed. Unfortunately, these therapies are only effective for 5% of people with CF.

This project examines how a gene (called BGas) can be genetically manipulated for CF therapy. When BGas is removed from the cell, CFTR function is restored. This therapy will be beneficial to majority of CF patients around the globe – not just 5%.

Miniaturized versions of CF patient gut (mini-gut), using their own cells as starting material are created in the lab. followed by BGas-removing compounds being added to the “mini-gut” to identify those responsive to BGas therapy.

The invaluable results from this project could drive future trials, delivering BGas-removing compounds directly to the CF patients. A similar approach has had promising outcomes for children with spinal muscular atrophy. The discovery of BGas-removing compounds may finally offer light at the end of the tunnel for CF therapy.

Reports: None due

Back to top>

Hardie Foundation Scholarship - WA Top Up Grant 2017

Project Title: The role of Interleukin and necrosis leading to neutrophilic inflammation in children with cystic fibrosis.

Name: Samuel Montgomery

Institution: Telethon Kids Institute WA

Value: $ 37,500

Duration: 3 years

Summary: This study aims to determine whether inflammation resulting from cell death in the airway is increased in early lung disease in Cystic Fibrosis (CF). It also aims to identify differences in specific gene pathways during inflammation resulting from cell death in the CF airway.

Back to top>

CFWA Golf Classic Scholarship - WA Top Up Grant 2017

Project Title: Personalised antisense oligonucleotide therapy to correct CFTR function in Cystic Fibrosis patients.

Name: Kelly Martinovich

Institution: School of Paediatrics and Child Health, Princess Margaret Hospital WA

Value: $ 37,500

Duration: 3 years

Summary: Current on the market small molecule therapies do not help all patients with CF, since it is caused by over 2000 different mutations. Here, we aim to develop therapies that target the more rare CF mutations. Many mutations change the message that is passed on from the CF gene. This faulty message results in a poorly functioning CFTR channel. The CFTR channel maintains the airway surface liquid in the lungs that helps clears infections.

The therapies that we will aim to develop are another type of small molecule called antisense oligonucleotides (AOs).  AOs can change the faulty message transferred from gene to protein and improve the function of the CFTR protein. Furthermore, AOs can be designed to target a specific site in the CF gene depending on the location and effect of the CF causing mutation that the specific person holds. In predicted cases, AOs in theory could reduce the severity of CF. It is hoped that this study will initiate a personalised medicine pathway generating molecules that lessen the disease severity caused by specific CF-causing mutations.

Back to top>

Abbie Fennessy Memorial Fellowship 2017

 (supported by Technipro-Pulmomed Pty Ltd & Cystic Fibrosis Australia)

Project Title: Airway Clearance Adherence Monitoring System (ACAMS) – development and initial benchtop trial.

Name: Nathan Ward

Institution: Royal Adelaide Hospital (RAH)

Value: $ 5,000

Duration: 1 year

Summary: As part of his PhD candidature at La Trobe University, Nathan developed an electronic device that can potentially be used for both clinical and research assessment of adherence to positive pressure-based airway clearance techniques. The device has been called the Airway Clearance Adherence Monitoring System (ACAMS).

Using the funds provided through the Abbie Fennessy Memorial Fellowship, five ACAMS units will undergo independent pressure accuracy testing against Australian standards. Following this testing, the five units will undergo an initial benchtop trial to prove their utility with PariPEP S, PariOPEP and Acapella DH devices for a one week period for each device.

If this initial benchtop study demonstrates that the ACAMS device can accurately record performance of these techniques and provide analysable data on the quality of the technique performance, these data will be used to support applications for an initial pilot clinical trial. It is envisaged that this trial would recruit adults with cystic fibrosis attending the Royal Adelaide Hospital Adult Cystic Fibrosis Service.

The Abbie Fennessy Memorial Fellowship will also be used to cover the costs for Nathan to attend the North American Cystic Fibrosis Conference (NACFC) in October 2018, where he will I will be submitting an abstract on the development and benchtop validation of the ACAMS device along with two other abstracts for presentation at the NACFC.

Reports - none due

Back to top>

ACFRT Top-up Scholarship - 2018

Project Title: Understanding the Mechanism of Interations between Anti-Inflammatory and Antibiotics for Optimal Cystic Fibrosis Treatment

Name: Zara Sheikh

Institution: Discipline of Pharmacology, School of Medicine, University of Sydney

Duration: 3 years

Value: $ 5,000

Summary: The mainstay of current Cystic Fibrosis (CF) treatment is based on chronic antibiotics therapy delivered by inhalation, as adjunct to either oral/inhaled anti-inflammatory drugs, and/or oral/intravenous antibiotics to treat pulmonary exacerbations.

This project will investigate the different combinations of anti-inflammatory and antibiotics used in CF treatment to unravel their interactions, and understand if their combined use could potentially impact on their efficacy and treatment outcomes.

This project could potentially improve the day-to-day lives of CF patients, reducing the treatment burden, shortening treatments times and decreasing treatment cost, ultimately improving quality of life.

Reports: None Due

Back to top>

ACFRT Top-up Scholarship - 2017

Project Title: Does high intensity interval training improve fitness in people with cystic fibrosis?

Name: Abbey Sawyer

Institution: School of Physiotherapy and Exercise Science, Curtin University WA             

Duration: 3 years

Value: $ 5,000

Summary: People with cystic fibrosis (CF) who are fitter have improved quality of life and may live longer.

Currently, people with CF are encourage to exercise for 30 to 60 minutes a day, in line with recommendations provided for people who are healthy. This is often difficult to achieve due to the high daily treatment burden and competing demands in life such as work, study and family.

This project will investigate whether 10 minutes of high intensity interval training over an 8-week period improves fitness and other important outcomes such as quality of life, mood, confidence to complete exercise and enjoyment in people with CF.

Reports: None due

Back to top>

ACFRT Top-up Scholarship - 2017

Project Title: Are altered carbohydrates associated with compromised immune cells in cystic fibrosis?

Name: Harry Tjondro

Institution: Department of Chemistry & Biomolecular Science – Macquarie University

Value: $ 5,000

Duration: 3 years

Summary: This project will for the first time use biochemistry to explore the aberrant carbohydrate signatures and their functional significance on CF neutrophils relative to healthy neutrophils, an important type of innate immune cells in CF.

Advancing our understanding of the structural and functional alterations of carbohydrates in CF neutrophils will be valuable in order to unravel the underlying disease mechanisms.

This study will generate valuable, fundamental biochemical knowledge to support the generation of new immune-based therapeutics to alleviate the disease burden of affected individuals.

Reports: None due

Back to top>

ACFRT Top-up Scholarship - 2017

Project Title: Pseudomonas aeruginosa behavior in cystic fibrosis: new insights using novel super-resolution microscopy.

Name: Simone Visser

Institution: Department of Respiratory Medicine – RPAH, NSW

Value: $ 5,000

Duration: 3 years

Summary: In 2017, I was awarded $5,000 for 3 years for the Postgraduate Studentship Grant from the Australian Cystic Fibrosis Research Trust (ACFRT) to investigate novel combination anti-biofilm treatment for emerging cystic fibrosis pathogens. 

The Grant allowed me to begin investigating new antibacterial treatments for chronic lung infections in cystic fibrosis (CF).

Pseudomonas aeruginosa and other emerging bacterial pathogens (multi-resistant Staphylococcus aureus, Achromobacter xylosoxidans, Stenotrophomonas maltophilia) establish chronic lung infections in patients with cystic fibrosis by forming biofilms in the airways. 

Biofilms are adherent, slimy layers of bacteria, which are highly impermeable and resistant to antibiotic therapy, making treatment very challenging. It is well recognised that after development of chronic bacterial lung infections, patients experience deterioration in lung function, increased flare-ups and poorer survival.  There is an urgent need to develop new effective treatments against bacteria and their biofilms.

Our group has found that innovative triple combination therapy (glutathione/DNase/antibiotic) is effective in reducing pseudomonas biofilms (Ashish Kumar et al, Frontiers in Microbiology 2017; 8:1-18).  I am now expanding that work into the emerging CF pathogens, which are typically under-studied and include achromobacter, stenotrophomonas, and methicillin-resistant staphylococcus aureus. According to recent registry data, these bacterial species are increasingly common in CF patients. Further, chronic infection with these bacteria is linked with poorer lung health. I am investigating whether similar triple combination therapy is effective against the biofilms of these bacteria.

I am currently working at the Royal Prince Alfred Hospital in the field of Cystic Fibrosis and Bronchiectasis.

The ACFRT Grant has allowed me to begin investigating innovative combination antibacterial therapy to treat chronic lung infections in cystic fibrosis.  The combination treatment targets bacterial biofilms (slimy layer), which is usually impenetrable and resistant to typical antibiotic therapies.

Reports: None due

Back to top>

ACFRT in conjunction with CFSA Special Grant 2018

Project Title: A novel treatment strategy for cystic fibrosis S. aureus-associated chronic rhinosinusitis

Name: Professor P-J Wormald

Institution: Adelaide and Flinders Universites 

Duration: 1 year

Summary: Chronic Rhinosinusitis (CRS) is one of the most common manifestations in patients with Cystic Fibrosis (CF) contributing to CF lung disease. The frequent and often long-term use of antibiotics to treat relapsing airway infections significantly contributes to the threat of Multi Drug Resistant (MDR) pathogens. There is an urgent need for the development of new treatments that are effective at eliminating infections with MDR pathogens.

Bacteriophage (phage) is a virus that targets and kills one specific bacterial species, leaving the human mucosa and commensal species unaffected. In collaboration with Ampliphi Biosciences, our team has recently successfully completed a human clinical trial to test the safety and preliminary efficacy of a phage cocktail to treat S. aureus CRS. We have further improved this treatment to develop a novel phage-based formulation that is now able to eradicate rather than reduce S. aureus including MDR S. aureus (MRSA).

This project brings together our Adelaide-based Rhinology team (Prof PJ Wormald and A/Prof S Vreugde) with CF centres located in Adelaide and at the Royal Brompton Hospital (RBH) in London. The team aims to optimise the delivery of the new formulation to make it suitable for topical delivery to the sinus region in CF patients.

ACFRT in conjunction with CFSA Special Grant 2018

Project Title: Lentiviral Mediated Airway Gene Therapy: Is lysophosphatidylcholine requires for safe and effective gene transfer in a cystic fibrosis lung?

Name: Chantelle Carpentieri

Institution: University of Adelaide & Women's and Children's Hospital 

Value: $30,000

Duration: 3 years

Summary: To follow

Reports: None Due

Back to top>

Antimicrobial Resistance In Cystic Fibrosis

International Task force

The prevalence of antimicrobial resistance (AMR) among microbial pathogens is increasing and is a high priority worldwide for interventions from antibiotic stewardship to new antibiotic development (http://www.who.int/antimicrobial-resistance/en/).  Increasing AMR prevalence is driven by the widespread use of antibiotics.

AMR is commonly encountered in bacteria and fungi isolated from the airways of people with cystic fibrosis (CF).  This is an expected finding given the high use of antibiotics in CF patients. The increasing survival of people with CF will result in greater lifetime exposure to antibiotics.

There is a lack of full understanding for stakeholders including people with CF, clinicians, the pharmaceutical industry, and (drug approving) regulatory bodies, about the relevance of AMR and how this should influence drug development and usage in the treatment of CF lung disease.

The Taskforce will develop guidelines on the interpretation of AMR for clinical care in CF. The Taskforce will also provide guidance on the role of AMR in clinical trials with new antimicrobial agents. The Taskforce that will have international and multidisciplinary representation will address the following objectives:

  • Understand how chronic infections differ from acute infections with respect to the microbiological assumptions regarding AMR.
  • Describe current and developing methodologies for determining antimicrobial resistance.
  • Assess the value of current susceptibility testing including the frequency and timing of testing.
  • Offer guidance for the use of antimicrobial resistance testing in the conduct of clinical trials by the pharmaceutical industry and regulatory agencies.
  • Set key research priorities for the development of appropriate future application of AMR diagnostics to improve patient outcomes.
  • Explore how monitoring antibiotic usage impacts on AMR in people with CF.

Australia/New Zealand Representatives

  • Cass Byrnes, CF pediatrician
  • Jason Roberts, pharmacist
  • Tim Kidd, microbiologist
  • Scott Bell, adult CF physician

 

Update February 2018

Thanks again to CFA for their support of this international working group. The working group met at the North American CF Conference and had approximately 50 to 60 participants.

Five groups have been established:

  1. Antimicrobial resistance definitions 
  2. Literature review and development of current evidence 
  3. Antimicrobial stewardship 
  4. Education for clinicians, patients, families and participants 

Since that meeting, the Steering Committee Group have had a teleconference to report the update. All four groups are demonstrating rapid progression. The aim is to meet again in Artimino in September 2018 in order to finalise the recommendations of the working group for antimicrobial resistance in cystic fibrosis.

Findings of the groups are anticipated to be presented in a symposium of the North American CF Conference in Denver in October 2018 and again in the European CF Conference in Liverpool in June 2019. 

At least three publications are likely to be generated by the working group but importantly will provide the clinician, research and patient community with an update on AMR in cystic fibrosis.

Special Grant 2016

Project Title: Multi-action antibiotics to treat chronic biofilm infections

Name: Michael Kelso

Institution: University of Wollongong

Duration: 3 years

Summary: Biofilms often build up in the lungs of people with CF. They contain large populations of bacterial cells and are encapsulated within gum-like materials which protect bacteria against the action of antibiotics and against the action of cells in the patient’s immune system.

Antibiotic resistance can be increased up to 1000-fold in biofilms. Associate Professor Michael Kelso from UOW together with members of his research team were the first to discover that low concentrations of nitric oxide (NO) act as a signal that triggers bacteria in biofilms to disperse. When this happens the bacteria become more sensitive to antibiotics and to the body’s immune system. This project investigates the effects of combinations of NO-releasing compounds with antibiotics (cephalosporins) to develop a new way of targeting delivery of NO to biofilms.

Reports:

Back to top