Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1683-1692

Evidence that Systemic Gentamicin Suppresses Premature Stop Mutations in Patients with Cystic Fibrosis

J. P. CLANCY, ZSUZSA BEBÖK, FADEL RUIZ, CHRIS KING, JULIE JONES, LYNN WALKER, HEATHER GREER, JEONG HONG, LISA WING, MAURIZIO MACALUSO, RAYMOND LYRENE, ERIC J. SORSCHER, and DAVID M. BEDWELL

Departments of Pediatrics, Cell Biology, Medicine, Medical Genetics, Public Health, and Microbiology, University of Alabama at Birmingham; Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham; Children's Hospital, Birmingham, Alabama; and Department of Pediatrics, University of Mississippi, Jackson, Mississippi

Here we report the effects of gentamicin treatment on cystic fibrosis transmembrane regulator (CFTR) production and function in CF airway cells and patients with CF with premature stop mutations. Using immunocytochemical and functional [6-methoxy-N- (3-sulfopropyl) quinolinium (SPQ)-based] techniques, ex vivo exposure of airway cells from stop mutation CF patients led to the identification of surface-localized CFTR in a dose-dependent fashion. Next, five patients with CF with stop mutations and five CF control subjects were treated with parenteral gentamicin for 1 wk, and underwent repeated in vivo measures of CFTR function (nasal potential difference [PD] measurements and sweat chloride [Cl] testing). During the treatment period, the number of nasal PD readings in the direction of Cl secretion was increased approximately 3-fold in the stop mutation patient group compared with controls (p < 0.001), and four of five stop mutation patients with CF had at least one reading during gentamicin treatment with a Cl secretory response of more than 5 mV (hyperpolarized). A response of this magnitude was not seen in any of the CF control subjects (p < 0.05). In an independent series of experiments designed to test the ability of repeat nasal PDs to detect wild-type CFTR function, evidence of Cl secretion was seen in 88% of control (non-CF) nasal PDs, and 71% were more than 5 mV hyperpolarized. Together, these results suggest that gentamicin treatment can suppress premature stop mutations in airway cells from patients with CF, and produce small increases in CFTR Cl conductance (as measured by the nasal PD) in vivo.

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