Cystic fibrosis transmembrane conductance regulator (CFTR) maintains epithelial function by acting as an ion channel at the apical surface of epithelial cells, and governs the formation of mucus and its clearance. Genetic mutations of CFTR cause CF, and these mutations also contribute to other airway diseases by altering host defense. We have helped discover that CFTR dysfunction also can be acquired in the absence of congenital mutations, contributing to the pathogenesis of the chronic bronchitis phenotype of chronic obstructive pulmonary disease (COPD). To this aim, this Research Program will make decisive advancements in elucidating the pathogenesis of airway diseases linked to genetic and acquired CFTR dysfunction, and will apply this knowledge to develop new tools for their diagnosis and treatment. The Program will encompass two focus areas critical to the mission of the NHLBI. The first will tackle fundamental questions surrounding mucus clearance, using CF as the model. We will implement in vivo ?OCT imaging, a technique we co-invented that provides an unprecedented view of the functional microanatomy of the airway surface; perform innovative techniques to probe airway mucus; and use a novel CF rat that exhibits delayed mucus clearance and an inherit defect in host defense that develops over time to 1) illuminate mechanisms governing the formation of mucus and its clearance, 2) develop novel therapeutic approaches targeting abnormal mucus itself, and 3) establish mechanisms underlying increased susceptibility to chronic bacterial infection and novel strategies for bacterial eradication. In the second focus area, we will study the role of these pathways in chronic bronchitis, a prevalent disorder that lacks treatments that reverse its natural history. We will determine 1) the impact of acquired CFTR dysfunction in ferrets, the first animal model of chronic bronchitis, 2) mechanisms of mucus stasis in the human COPD airway (and contrast with CF), 3) whether acquired CFTR dysfunction increases susceptibility to chronic bacterial infection or respiratory exacerbations in COPD ferrets, and 4) test novel therapies for chronic bronchitis, including advancing CFTR potentiators for this indication. There will be significant synergy between these studies, which will not only employ cutting-edge techniques and animal models but also take advantage of our recognized expertise in leading first-in-class human investigation into CFTR-directed therapies. Noting Dr. Rowe's consistent track record of successes; the innovative, one-of-a-kind capabilities of his laboratory; and the immediate feasibility of proposed objectives, this Program promises to transform the field and uncover treatments that offer momentous improvements to duration and quality of life.

Public Health Relevance

Genetic mutations of cystic fibrosis transmembrane conductance regulator (CFTR) cause CF, and an acquired form of CFTR dysfunction also contributes to the chronic bronchitis phenotype of chronic obstructive pulmonary disease (COPD) by altering mucus clearance and host defense. This Research Program will lead the way in transforming the field by answering critical questions regarding CFTR-related airway disease pathophysiology and employing innovative means for testing and monitoring responses to novel therapeutics to develop transformative treatment strategies for these disorders.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Unknown (R35)
Project #
5R35HL135816-02
Application #
9412520
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Sheridan, John T
Project Start
2017-01-15
Project End
2023-12-31
Budget Start
2018-01-01
Budget End
2018-12-31
Support Year
2
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Alabama Birmingham
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
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McCormick, Lydia L; Phillips, Scott E; Kaza, Niroop et al. (2018) Maternal Smoking Induces Acquired CFTR Dysfunction in Neonatal Rats. Am J Respir Crit Care Med 198:672-674
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Shei, Ren-Jay; Peabody, Jacelyn E; Rowe, Steven M (2018) Functional Anatomic Imaging of the Airway Surface. Ann Am Thorac Soc 15:S177-S183
Clancy, John Paul; Cotton, Calvin U; Donaldson, Scott H et al. (2018) CFTR modulator theratyping: Current status, gaps and future directions. J Cyst Fibros :
Heltshe, Sonya L; Rowe, Steven M; Skalland, Michelle et al. (2018) Ivacaftor-treated Patients with Cystic Fibrosis Derive Long-Term Benefit Despite No Short-Term Clinical Improvement. Am J Respir Crit Care Med 197:1483-1486

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