Ivacaftor in a young boy with the rare gating mutation S549R - use of lung clearance index to track progress: a case report

Abstract

BackgroundIvacaftor acts as a potentiator of the cystic fibrosis transmembrane conductance regulator (CFTR) and increases the transepithelial chloride transport of CFTR in 9 of 10 known gating mutations causing cystic fibrosis. S549R is a rare gating mutation considered to be less sensitive to potentiators than all other gating mutations.Case presentationWe report our first experience with ivacaftor in an 8-year-old boy with the rare S549R gating mutation. Besides subjective clinical improvements, the sweat chloride level and the lung clearance index decreased impressively within a few weeks of treatment while forced expiratory volume in the first second values remained in normal range.ConclusionWe emphasize the value of measuring small airway function by lung clearance index as an outcome measure for new interventions targeting the correction of the CFTR defect at an age before traditional lung function parameters start to deteriorate.

Effectiveness of ivacaftor in cystic fibrosis patients with non-G551D gating mutations

“…This emphasizes that SC has important limitations as a clinical biomarker to predict effects on ppFEV 1 across the entire spectrum of the CF patient population, and cannot be used on an individual basis for all patients [25–28]. In children, other modalities of lung function assessment, such as the lung clearance index (LCI), may be more applicable since this measure has been shown to be more sensitive to changes in lung function in children [29–31].…”