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This is a clinical study to evaluate a new medical system used to perform a sweat secretion-based test for the diagnosis of cystic fibrosis.
This clinical study will involve around 150 individuals in Belgium, including 50 healthy individuals, 50 carriers and 50 patients with cystic fibrosis.
The primary objective is to implement a new system for diagnosing cystic fibrosis according to their response to the beta-adrenergic test.
First session (50 minutes):
Second session (50 minutes):
The secondary objectives of this clinical research are:
The test consists of 5 steps:
At each stimulation steps (step 1 to 3), the pain level during the test will be evaluated by self assessment in adults with Visual Analog Scale and children 2 to 6 years old with Faces Pain Scale - Revised or a hetero-assessment of pain for children less than 2 years old with douleur aigue du nouveau-ne scale.
Cystic fibrosis (CF) is a rare genetic disease affecting 1 baby in 2,850 live births in Belgium and associated with high morbidity and mortality. CF is caused by CFTR mutations resulting in loss-of-function of the CFTR protein. It leads to dramatic abnormalities in transepithelial ion transport and the production of thick mucus obstructing airways and duct lumens of exocrine glands. The gold standard for CF diagnosis is an accurate Gibson and Cooke sweat test which is very sensitive to lost or abrogated CFTR function, but shows a logarithmic relationship between sweat Cl - content and CFTR function: e.g. a 5% residual CFTR function is associated with sweat Cl- concentrations found below the diagnostic threshold (<60 mmol/L). Consequently, diagnosing CF is challenging in borderline cases and/or in the presence of CFTR mutations not recognized as disease-causing (CFTR2 data base; https://cftr2.org/). Contrary to routine sweat test measuring the CFTR-mediated reabsorption of Cl- in the sweat duct, beta-adrenergic sweat secretion test (BAST) measures CFTR mediated secretion of Cl- in the secretory coil of the sweat gland . Sato and Sato discovered in the early 1980s that CFTR-mediated sweat secretion can be stimulated with β-adrenergic agonists if the thermoregulative cholinergic sweat secretion is simultaneously inhibited with atropine . β-adrenergic sweat secretion was absent in people with CF (pwCF) and half-maximal in healthy heterozygous carriers of CFTR mutation (HTZ). Therefore, BAST seems to be a highly sensitive CFTR bioassay suitable for screening of CFTR dysfunction, monitoring the efficacy of new therapeutic interventions and differential diagnosis of exocrine pancreatic sufficient-CF, CFTR-Related disease and cystic fibrosis screen positive and finallyinconclusive diagnosis. BAST detect the relative improvement due to a novel treatment, while at the same time show that the levels did not return to a normal range. The available measurement range can thus be used to assess the individual response to therapeutic interventions, but can also be used to stratify patients in the intermediate range of activity, which fall into a spectrum, ranging from a severe loss of function in classical cystic fibrosis to the cystic fibrosis related disease with a relatively lowered activity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| EVALUATION OF NEW SYSTEM FOR β-ADRENERGIC SWEAT TEST IN THE CONTEXT OF STRATIFICATION OF PATIENT WI | Experimental | First session (50 minutes):
Second session (50 minutes):
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sweat stimulation and secretion quantification | Device | First session (50 minutes): a. Left arm: Iontophoresis using the Macroduct for the cholinergic and β-adrenergic stimulation (2 iontophoresis), then bubble test. b. right arm: Iontophoresis using the Macroduct for the cholinergic and β-adrenergic stimulation (2 iontophoresis), then evaporimetry. Second session (50 minutes): a. Left arm: Iontophoresis using the Macroduct for the cholinergic and intradermal injection for the β-adrenergic stimulation, then bubble test. b. Right arm: Iontophoresis using the Macroduct for the cholinergic and intradermal injection for the β-adrenergic stimulation, then evaporimetry. |
| Measure | Description | Time Frame |
|---|---|---|
| Sweat secretion | To distinguish people with cystic fibrosis, the beta-adrenergic sweat rate less than or equal to 4.5 TEWL and the beta-adrenergic:cholinergic ratio less than or equal to 0.05 measured by the evaporimetry test will be used. For the bubble test, a β-adrenergic sweat rate of less than 0.16 nL/min will be used to define a CF base range. | 2 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Pain assessment score | Pain during the test will be assessed by self-report in adults and children >6 years old, or by hetero-report in children <6 years old. A score > 3-4/10 leads to discontinuation of the test. | 2 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sophie Gohy, MD,PhD | Contact | +32 2 764 80 64 | sophie.gohy@uclouvain.be | |
| Angélique Mottais | Contact | angelique.mottais@uclouvain.be |
| Name | Affiliation | Role |
|---|---|---|
| Sophie Gohy | Cliniques universitaires Saint-Luc- Université Catholique de Louvain | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cliniques Universitaires Saint-Luc | Recruiting | Brussels | 1200 | Belgium |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34756683 | Background | Pallenberg ST, Junge S, Ringshausen FC, Sauer-Heilborn A, Hansen G, Dittrich AM, Tummler B, Nietert M. CFTR modulation with elexacaftor-tezacaftor-ivacaftor in people with cystic fibrosis assessed by the beta-adrenergic sweat rate assay. J Cyst Fibros. 2022 May;21(3):442-447. doi: 10.1016/j.jcf.2021.10.005. Epub 2021 Oct 29. | |
| 36193559 |
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|
| Zampoli M, Verstraete J, Nguyen-Khoa T, Sermet-Gaudelus I, Zar HJ, Gonska T, Morrow BM. beta-adrenergic sweat test in children with inconclusive cystic fibrosis diagnosis: Do we need new reference ranges? Pediatr Pulmonol. 2023 Jan;58(1):187-196. doi: 10.1002/ppul.26179. Epub 2022 Oct 17. |
| 34489187 | Background | Reynaerts A, Vermeulen F, Mottais A, Gohy S, Lebecque P, Frederick R, Vanbever R, Leal T. Needle-free iontophoresis-driven beta-adrenergic sweat rate test. J Cyst Fibros. 2022 May;21(3):407-415. doi: 10.1016/j.jcf.2021.08.012. Epub 2021 Sep 4. |
| ID | Term |
|---|---|
| D003550 | Cystic Fibrosis |
| ID | Term |
|---|---|
| D010182 | Pancreatic Diseases |
| D004066 | Digestive System Diseases |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007232 | Infant, Newborn, Diseases |
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