Effects of a partially supervised conditioning programme in cystic fibrosis: an international multi-centre randomised controlled trial (ACTIVATE-CF): study protocol

Physical activity (PA) and exercise have become an accepted and valued component of cystic fibrosis (CF) care. Regular PA and exercise can positively impact pulmonary function, improve physical fitness, and enhance health-related quality of life (HRQoL). However, motivating people to be more active is challenging. Supervised exercise programs are expensive and labour intensive, and adherence falls off significantly once supervision ends. Unsupervised or partially supervised programs are less costly and more flexible, but compliance can be more problematic. The primary objective of this study is to evaluate the effects of a partially supervised exercise intervention along with regular motivation on forced expiratory volume in 1 s (FEV1) at 6 months in a large international group of CF patients. Secondary endpoints include patient reported HRQoL, as well as levels of anxiety and depression, and control of blood sugar.; It is planned that a total of 292 patients with CF 12 years and older with a FEV1 ≥ 35% predicted shall be randomised. Following baseline assessments (2 visits) patients are randomised into an intervention and a control group. Thereafter, they will be seen every 3 months for assessments in their centre for one year (4 follow-up visits). Along with individual counselling to increase vigorous PA by at least 3 h per week on each clinic visit, the intervention group documents daily PA and inactivity time and receives a step counter to record their progress within a web-based diary. They also receive monthly phone calls from the study staff during the first 6 months of the study. After 6 months, they continue with the step counter and web-based programme for a further 6 months. The control group receives standard care and keeps their PA level constant during the study period. Thereafter, they receive the intervention as well.; This is the first large, international multi-centre study to investigate the effects of a PA intervention in CF with motivational feedback on several health outcomes using modern technology. Should this relatively simple programme prove successful, it will be made available on a wider scale internationally.; ClinicalTrials.gov Identifier: NCT01744561 ; Registration date: December 6, 2012

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations

An optimal nutritional status is associated with better post-transplant outcomes and survival. Post-lung transplant nutrition management is however particularly challenging as lung recipients represent a very heterogeneous group of patients in terms of age, underlying diseases, weight status and presence of comorbidities. Furthermore, the post-transplant period encompasses several stages characterized by physiological and pathophysiological changes that affect nutritional status of patients and necessitate tailored nutrition management. We provide an overview of the current state of knowledge regarding nutritional requirements in the post-lung transplant period from the immediate post-operative phase to long-term follow-up. In the immediate post-transplantation phase, the high doses of immunosuppressants and corticosteroids, the goal of maintaining hemodynamic stability, the presence of a catabolic state, and the wound healing process increase nutritional demands and lead to metabolic perturbations that necessitate nutritional interventions. As time from transplantation increases, complications such as obesity, osteoporosis, cancer, diabetes, and kidney disease, may develop and require adjustments to nutrition management. Until specific nutritional guidelines for lung recipients are elaborated, recommendations regarding nutrient requirements are formulated to provide guidance for clinicians caring for these patients. Finally, the management of recipients with special considerations is also briefly addressed

Clinical Potential of Hyperbaric Pressure-Treated Whey Protein

Whey protein (WP) from cow’s milk is a rich source of essential and branched chain amino acids. Whey protein isolates (WPI) has been demonstrated to support muscle accretion, antioxidant activity, and immune modulation. However, whey is not readily digestible due to its tight conformational structure. Treatment of WPI with hyperbaric pressure results in protein unfolding. This enhances protein digestion, and results in an altered spectrum of released peptides, and greater release of essential and branched chain amino acids. Pressurized whey protein isolates (pWPI), through a series of cell culture, animal models and clinical studies, have been demonstrated to enhance muscle accretion, reduce inflammation, improve immunity, and decrease fatigue. It is also conceivable that pWPI would be more accessible to digestive enzymes, which would allow for a more rapid proteolysis of the proteins and an increased or altered release of small bioactive peptides. The altered profile of peptides released from WP digestion could thus play a role in the modulation of the immune response and tissue glutathione (GSH) concentrations. The research to date presents potentially interesting applications for the development of new functional foods based on hyperbaric treatment of WPI to produce products with more potent nutritional and nutraceutical properties

High hydrostatic pressure pre-treatment of whey proteins enhances whey protein hydrolysate inhibition of oxidative stress and IL-8 secretion in intestinal epithelial cells

Background: High hyperbaric pressure treatment of whey protein isolate (WPI) causes changes in the protein structure that enhances the anti-oxidant and anti-inflammatory effects of WPI. Objective: The aim of this study was to compare the anti-oxidant and anti-inflammatory effects of pressurized whey protein isolate (pWPI) vs. native WPI (nWPI) hydrolysates in Caco-2 cells exposed to hydrogen peroxide (H2O2). Design: Cells were cultured with different concentrations of pWPI or nWPI hydrolysates either 1 h before or 1 h after H2O2. Cell viability, IL-8 secretion, intracellular reactive oxygen species (ROS), and the medium anti-oxidant capacity (FRAP assay) were measured. Results: Prior to and after H2O2 exposure, pWPI and nWPI hydrolysates inhibited IL-8 secretion and ROS generation, and increased FRAP activity in a dose-dependent manner. The maximal inhibition of H2O2-induced IL-8 secretion was greater with 2000 µg mL−1 of pWPI (50%) vs. nWPI (30%) hydrolysates. At the latter concentration, inhibition of H2O2-induced ROS formation reached 76% for pWPI, which was greater than for nWPI hydrolysates (32.5%). Conclusion: These results suggest that WPI hydrolysates can alleviate inflammation and oxidative stress in intestinal cells exposed to oxidative injury, which is further enhanced by hyperbaric pressure pre-treatment of WPI

Long-Term Impact of Bronchopulmonary Dysplasia on Pulmonary Function

BACKGROUND: Bronchopulmonary dysplasia (BPD) and the long-term respiratory consequences of prematurity are unfamiliar to adult respirologists and remain under-recognized entities to adult caregivers. In Canada, the incidence of preterm births and its main chronic respiratory complication, BPD, have increased over the past 25 years

Research Milestone Forecasting in Cystic Fibrosis

ABSTRACT: Background: Cystic fibrosis (CF) has seen important breakthroughs in the last few years. Physicians, experts, and patients anticipate further treatment advances in the coming years. Methods: In October 2021, CF experts in the US and Canada were asked to provide forecasts about 8 milestones in cystic fibrosis research in an online survey (Canadian experts provided forecasts about two additional milestones about healthcare system outcomes). CF experts were identified using lists of CF clinics available from major CF advocacy groups in the US and Canada. We randomized experts into two different experimental arms, comparing two different forecast elicitation approaches. Results: 81 experts completed the survey. Forecasts were not particularly optimistic about near term breakthroughs, though many events, including approval of anti-inflammatory drugs and approval of an amplifier drug were viewed as having at least a 40% chance of happening in the next 6 years. Experts were still less sanguine about other events, including FDA approval of effective antibiotics for B. Cepacia, FDA approval of a therapy for those with stop mutations on both alleles and a Phase II trial testing a gene therapy (25%, 27%, and 27% probability of not occurring at all within the next 10 years). Overall, both elicitation methods produced very similar forecasts. Conclusions: Experts regard important advances like genetic therapy as unlikely to occur within the decade. However, experts are very optimistic about healthcare system access to new treatments, at least in Canada