Skip to main content
Journal of the Royal Society of Medicine logoLink to Journal of the Royal Society of Medicine
. 2005;98(Suppl 45):47–54.

Cystic fibrosis modifier genes.

Jane Davies 1, Eric Alton 1, Uta Griesenbach 1
PMCID: PMC1308808  PMID: 16025767

Abstract

Since the recognition that CFTR genotype was not a good predictor of pulmonary disease severity in CF, several candidate modifier genes have been identified. It is unlikely that a single modifier gene will be found, but more probable that several haplotypes in combination may contribute, which in itself presents a major methodological challenge. The aims of such studies are to increase our understanding of disease pathogenesis, to aid prognosis and ultimately to lead to the development of novel treatments.

Full Text

The Full Text of this article is available as a PDF (89.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Accurso Frank J., Sontag Marci K. Seeking modifier genes in cystic fibrosis. Am J Respir Crit Care Med. 2003 Feb 1;167(3):289–290. doi: 10.1164/rccm.2210006. [DOI] [PubMed] [Google Scholar]
  2. Altshuler D., Hirschhorn J. N., Klannemark M., Lindgren C. M., Vohl M. C., Nemesh J., Lane C. R., Schaffner S. F., Bolk S., Brewer C. The common PPARgamma Pro12Ala polymorphism is associated with decreased risk of type 2 diabetes. Nat Genet. 2000 Sep;26(1):76–80. doi: 10.1038/79216. [DOI] [PubMed] [Google Scholar]
  3. Arkwright P. D., Laurie S., Super M., Pravica V., Schwarz M. J., Webb A. K., Hutchinson I. V. TGF-beta(1) genotype and accelerated decline in lung function of patients with cystic fibrosis. Thorax. 2000 Jun;55(6):459–462. doi: 10.1136/thorax.55.6.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Arkwright Peter D., Pravica Vera, Geraghty Philip J., Super Maurice, Webb A. Kevin, Schwarz Martin, Hutchinson Ian V. End-organ dysfunction in cystic fibrosis: association with angiotensin I converting enzyme and cytokine gene polymorphisms. Am J Respir Crit Care Med. 2003 Feb 1;167(3):384–389. doi: 10.1164/rccm.200204-364OC. [DOI] [PubMed] [Google Scholar]
  5. Armstrong D. S., Grimwood K., Carlin J. B., Carzino R., Olinsky A., Phelan P. D. Bronchoalveolar lavage or oropharyngeal cultures to identify lower respiratory pathogens in infants with cystic fibrosis. Pediatr Pulmonol. 1996 May;21(5):267–275. doi: 10.1002/(SICI)1099-0496(199605)21:5<267::AID-PPUL1>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
  6. Aron Y., Bienvenu T., Hubert D., Dusser D., Dall'Ava J., Polla B. S. HLA-DR polymorphism in allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 1999 Oct;104(4 Pt 1):891–892. doi: 10.1016/s0091-6749(99)70306-4. [DOI] [PubMed] [Google Scholar]
  7. Aron Y., Polla B. S., Bienvenu T., Dall'ava J., Dusser D., Hubert D. HLA class II polymorphism in cystic fibrosis. A possible modifier of pulmonary phenotype. Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1464–1468. doi: 10.1164/ajrccm.159.5.9807046. [DOI] [PubMed] [Google Scholar]
  8. Boekholdt S. Matthijs, Peters Ron J. G., de Maat Moniek P. M., Zwinderman Aeilko H., van Der Wall Ernst E., Reitsma Pieter H., Jukema J. Wouter, Kastelein John J. P. Interaction between a genetic variant of the platelet fibrinogen receptor and fibrinogen levels in determining the risk of cardiovascular events. Am Heart J. 2004 Jan;147(1):181–186. doi: 10.1016/j.ahj.2003.07.008. [DOI] [PubMed] [Google Scholar]
  9. Boyle Michael P. Nonclassic cystic fibrosis and CFTR-related diseases. Curr Opin Pulm Med. 2003 Nov;9(6):498–503. doi: 10.1097/00063198-200311000-00009. [DOI] [PubMed] [Google Scholar]
  10. Bronsveld I., Mekus F., Bijman J., Ballmann M., de Jonge H. R., Laabs U., Halley D. J., Ellemunter H., Mastella G., Thomas S. Chloride conductance and genetic background modulate the cystic fibrosis phenotype of Delta F508 homozygous twins and siblings. J Clin Invest. 2001 Dec;108(11):1705–1715. doi: 10.1172/JCI12108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Büscher Rainer, Eilmes Katrin Jennifer, Grasemann Hartmut, Torres Brian, Knauer Nicola, Sroka Karin, Insel Paul A., Ratjen Felix. beta2 adrenoceptor gene polymorphisms in cystic fibrosis lung disease. Pharmacogenetics. 2002 Jul;12(5):347–353. doi: 10.1097/00008571-200207000-00002. [DOI] [PubMed] [Google Scholar]
  12. Chen X., Sullivan P. F. Single nucleotide polymorphism genotyping: biochemistry, protocol, cost and throughput. Pharmacogenomics J. 2003;3(2):77–96. doi: 10.1038/sj.tpj.6500167. [DOI] [PubMed] [Google Scholar]
  13. Cuppens H., Lin W., Jaspers M., Costes B., Teng H., Vankeerberghen A., Jorissen M., Droogmans G., Reynaert I., Goossens M. Polyvariant mutant cystic fibrosis transmembrane conductance regulator genes. The polymorphic (Tg)m locus explains the partial penetrance of the T5 polymorphism as a disease mutation. J Clin Invest. 1998 Jan 15;101(2):487–496. doi: 10.1172/JCI639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Duthie A., Doherty D. G., Donaldson P. T., Scott-Jupp R., Tanner M. S., Eddleston A. L., Mowat A. P. The major histocompatibility complex influences the development of chronic liver disease in male children and young adults with cystic fibrosis. J Hepatol. 1995 Nov;23(5):532–537. doi: 10.1016/0168-8278(95)80058-1. [DOI] [PubMed] [Google Scholar]
  15. Döring G., Krogh-Johansen H., Weidinger S., Høiby N. Allotypes of alpha 1-antitrypsin in patients with cystic fibrosis, homozygous and heterozygous for deltaF508. Pediatr Pulmonol. 1994 Jul;18(1):3–7. doi: 10.1002/ppul.1950180104. [DOI] [PubMed] [Google Scholar]
  16. Dörk T., Wulbrand U., Richter T., Neumann T., Wolfes H., Wulf B., Maass G., Tümmler B. Cystic fibrosis with three mutations in the cystic fibrosis transmembrane conductance regulator gene. Hum Genet. 1991 Aug;87(4):441–446. doi: 10.1007/BF00197165. [DOI] [PubMed] [Google Scholar]
  17. Eggermont E. Gastrointestinal manifestations in cystic fibrosis. Eur J Gastroenterol Hepatol. 1996 Aug;8(8):731–738. [PubMed] [Google Scholar]
  18. Frangolias Despina D., Ruan Jian, Wilcox Pearce J., Davidson A. George F., Wong Lawrence T. K., Berthiaume Yves, Hennessey Rosamund, Freitag Andreas, Pedder Linda, Corey Mary. Alpha 1-antitrypsin deficiency alleles in cystic fibrosis lung disease. Am J Respir Cell Mol Biol. 2003 Apr 14;29(3 Pt 1):390–396. doi: 10.1165/rcmb.2002-0271OC. [DOI] [PubMed] [Google Scholar]
  19. Förstermann U., Boissel J. P., Kleinert H. Expressional control of the 'constitutive' isoforms of nitric oxide synthase (NOS I and NOS III). FASEB J. 1998 Jul;12(10):773–790. [PubMed] [Google Scholar]
  20. Gabolde M., Guilloud-Bataille M., Feingold J., Besmond C. Association of variant alleles of mannose binding lectin with severity of pulmonary disease in cystic fibrosis: cohort study. BMJ. 1999 Oct 30;319(7218):1166–1167. doi: 10.1136/bmj.319.7218.1166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Gabolde M., Hubert D., Guilloud-Bataille M., Lenaerts C., Feingold J., Besmond C. The mannose binding lectin gene influences the severity of chronic liver disease in cystic fibrosis. J Med Genet. 2001 May;38(5):310–311. doi: 10.1136/jmg.38.5.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Garred P., Pressler T., Madsen H. O., Frederiksen B., Svejgaard A., Høiby N., Schwartz M., Koch C. Association of mannose-binding lectin gene heterogeneity with severity of lung disease and survival in cystic fibrosis. J Clin Invest. 1999 Aug;104(4):431–437. doi: 10.1172/JCI6861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Garred Peter, Pressler Tacjana, Lanng Susanne, Madsen Hans O., Moser Claus, Laursen Inga, Balstrup Flemming, Koch Claus, Koch Christian. Mannose-binding lectin (MBL) therapy in an MBL-deficient patient with severe cystic fibrosis lung disease. Pediatr Pulmonol. 2002 Mar;33(3):201–207. doi: 10.1002/ppul.10064. [DOI] [PubMed] [Google Scholar]
  24. Goetz Matthew P., Ames Matthew M., Weinshilboum Richard M. Primer on medical genomics. Part XII: Pharmacogenomics--general principles with cancer as a model. Mayo Clin Proc. 2004 Mar;79(3):376–384. doi: 10.4065/79.3.376. [DOI] [PubMed] [Google Scholar]
  25. Grasemann H., Knauer N., Büscher R., Hübner K., Drazen J. M., Ratjen F. Airway nitric oxide levels in cystic fibrosis patients are related to a polymorphism in the neuronal nitric oxide synthase gene. Am J Respir Crit Care Med. 2000 Dec;162(6):2172–2176. doi: 10.1164/ajrccm.162.6.2003106. [DOI] [PubMed] [Google Scholar]
  26. Grasemann Hartmut, Storm van's Gravesande Karin, Buscher Rainer, Knauer Nicola, Silverman Eric S., Palmer Lyle J., Drazen Jeffrey M., Ratjen Felix. Endothelial nitric oxide synthase variants in cystic fibrosis lung disease. Am J Respir Crit Care Med. 2002 Aug 15;167(3):390–394. doi: 10.1164/rccm.200202-155OC. [DOI] [PubMed] [Google Scholar]
  27. Greally P., Hussein M. J., Cook A. J., Sampson A. P., Piper P. J., Price J. F. Sputum tumour necrosis factor-alpha and leukotriene concentrations in cystic fibrosis. Arch Dis Child. 1993 Mar;68(3):389–392. doi: 10.1136/adc.68.3.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Groman Joshua D., Hefferon Timothy W., Casals Teresa, Bassas Lluís, Estivill Xavier, Des Georges Marie, Guittard Caroline, Koudova Monika, Fallin M. Daniele, Nemeth Krisztina. Variation in a repeat sequence determines whether a common variant of the cystic fibrosis transmembrane conductance regulator gene is pathogenic or benign. Am J Hum Genet. 2003 Dec 18;74(1):176–179. doi: 10.1086/381001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Henry M. T., Cave S., Rendall J., O'Connor C. M., Morgan K., FitzGerald M. X., Kalsheker N. An alpha1-antitrypsin enhancer polymorphism is a genetic modifier of pulmonary outcome in cystic fibrosis. Eur J Hum Genet. 2001 Apr;9(4):273–278. doi: 10.1038/sj.ejhg.5200623. [DOI] [PubMed] [Google Scholar]
  30. Hugot J. P., Chamaillard M., Zouali H., Lesage S., Cézard J. P., Belaiche J., Almer S., Tysk C., O'Morain C. A., Gassull M. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease. Nature. 2001 May 31;411(6837):599–603. doi: 10.1038/35079107. [DOI] [PubMed] [Google Scholar]
  31. Hull J., Thomson A. H. Contribution of genetic factors other than CFTR to disease severity in cystic fibrosis. Thorax. 1998 Dec;53(12):1018–1021. doi: 10.1136/thx.53.12.1018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Iacopetta B., Grieu F., Joseph D. The -174 G/C gene polymorphism in interleukin-6 is associated with an aggressive breast cancer phenotype. Br J Cancer. 2004 Jan 26;90(2):419–422. doi: 10.1038/sj.bjc.6601545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Kawabata Y., Ikegami H., Kawaguchi Y., Fujisawa T., Hotta M., Ueda H., Shintani M., Nojima K., Ono M., Nishino M. Age-related association of MHC class I chain-related gene A (MICA) with type 1 (insulin-dependent) diabetes mellitus. Hum Immunol. 2000 Jun;61(6):624–629. doi: 10.1016/s0198-8859(00)00118-x. [DOI] [PubMed] [Google Scholar]
  34. Kerem E., Corey M., Kerem B. S., Rommens J., Markiewicz D., Levison H., Tsui L. C., Durie P. The relation between genotype and phenotype in cystic fibrosis--analysis of the most common mutation (delta F508). N Engl J Med. 1990 Nov 29;323(22):1517–1522. doi: 10.1056/NEJM199011293232203. [DOI] [PubMed] [Google Scholar]
  35. Koch C., Høiby N. Pathogenesis of cystic fibrosis. Lancet. 1993 Apr 24;341(8852):1065–1069. doi: 10.1016/0140-6736(93)92422-p. [DOI] [PubMed] [Google Scholar]
  36. Mahadeva R., Lomas D. A. Genetics and respiratory disease. 2. Alpha 1-antitrypsin deficiency, cirrhosis and emphysema. Thorax. 1998 Jun;53(6):501–505. doi: 10.1136/thx.53.6.501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Mahadeva R., Sharples L., Ross-Russell R. I., Webb A. K., Bilton D., Lomas D. A. Association of alpha(1)-antichymotrypsin deficiency with milder lung disease in patients with cystic fibrosis. Thorax. 2001 Jan;56(1):53–58. doi: 10.1136/thorax.56.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Mahadeva R., Stewart S., Bilton D., Lomas D. A. Alpha-1 antitrypsin deficiency alleles and severe cystic fibrosis lung disease. Thorax. 1998 Dec;53(12):1022–1024. doi: 10.1136/thx.53.12.1022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Mahadeva R., Westerbeek R. C., Perry D. J., Lovegrove J. U., Whitehouse D. B., Carroll N. R., Ross-Russell R. I., Webb A. K., Bilton D., Lomas D. A. Alpha1-antitrypsin deficiency alleles and the Taq-I G-->A allele in cystic fibrosis lung disease. Eur Respir J. 1998 Apr;11(4):873–879. doi: 10.1183/09031936.98.11040873. [DOI] [PubMed] [Google Scholar]
  40. McKone Edward F., Emerson Scott S., Edwards Karen L., Aitken Moira L. Effect of genotype on phenotype and mortality in cystic fibrosis: a retrospective cohort study. Lancet. 2003 May 17;361(9370):1671–1676. doi: 10.1016/S0140-6736(03)13368-5. [DOI] [PubMed] [Google Scholar]
  41. Mekus Frauke, Laabs Ulrike, Veeze Henk, Tümmler Burkhard. Genes in the vicinity of CFTR modulate the cystic fibrosis phenotype in highly concordant or discordant F508del homozygous sib pairs. Hum Genet. 2002 Oct 3;112(1):1–11. doi: 10.1007/s00439-002-0839-7. [DOI] [PubMed] [Google Scholar]
  42. Mekus Frauke, Tümmler Burkhard. Cystic fibrosis and NOS3. Am J Respir Crit Care Med. 2004 Jan 15;169(2):319–320. doi: 10.1164/ajrccm.169.2.957. [DOI] [PubMed] [Google Scholar]
  43. Morgan T. M., Coffey C. S., Krumholz H. M. Overestimation of genetic risks owing to small sample sizes in cardiovascular studies. Clin Genet. 2003 Jul;64(1):7–17. doi: 10.1034/j.1399-0004.2003.00088.x. [DOI] [PubMed] [Google Scholar]
  44. Noone P. G., Pue C. A., Zhou Z., Friedman K. J., Wakeling E. L., Ganeshananthan M., Simon R. H., Silverman L. M., Knowles M. R. Lung disease associated with the IVS8 5T allele of the CFTR gene. Am J Respir Crit Care Med. 2000 Nov;162(5):1919–1924. doi: 10.1164/ajrccm.162.5.2003160. [DOI] [PubMed] [Google Scholar]
  45. Ramsay C. E., Hayden C. M., Tiller K. J., Burton P. R., Goldblatt J., Lesouef P. N. Polymorphisms in the beta2-adrenoreceptor gene are associated with decreased airway responsiveness. Clin Exp Allergy. 1999 Sep;29(9):1195–1203. doi: 10.1046/j.1365-2222.1999.00570.x. [DOI] [PubMed] [Google Scholar]
  46. Riordan J. R., Rommens J. M., Kerem B., Alon N., Rozmahel R., Grzelczak Z., Zielenski J., Lok S., Plavsic N., Chou J. L. Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA. Science. 1989 Sep 8;245(4922):1066–1073. doi: 10.1126/science.2475911. [DOI] [PubMed] [Google Scholar]
  47. Romey M. C., Guittard C., Chazalette J. P., Frossard P., Dawson K. P., Patton M. A., Casals T., Bazarbachi T., Girodon E., Rault G. Complex allele [-102T>A+S549R(T>G)] is associated with milder forms of cystic fibrosis than allele S549R(T>G) alone. Hum Genet. 1999 Jul-Aug;105(1-2):145–150. doi: 10.1007/s004399900066. [DOI] [PubMed] [Google Scholar]
  48. Romieu I., Sienra-Monge J. J., Ramírez-Aguilar M., Moreno-Macías H., Reyes-Ruiz N. I., Estela del Río-Navarro B., Hernández-Avila M., London S. J. Genetic polymorphism of GSTM1 and antioxidant supplementation influence lung function in relation to ozone exposure in asthmatic children in Mexico City. Thorax. 2004 Jan;59(1):8–10. [PMC free article] [PubMed] [Google Scholar]
  49. Rozmahel R., Wilschanski M., Matin A., Plyte S., Oliver M., Auerbach W., Moore A., Forstner J., Durie P., Nadeau J. Modulation of disease severity in cystic fibrosis transmembrane conductance regulator deficient mice by a secondary genetic factor. Nat Genet. 1996 Mar;12(3):280–287. doi: 10.1038/ng0396-280. [DOI] [PubMed] [Google Scholar]
  50. Rubinsztein D. C., Easton D. F. Apolipoprotein E genetic variation and Alzheimer's disease. a meta-analysis. Dement Geriatr Cogn Disord. 1999 May-Jun;10(3):199–209. doi: 10.1159/000017120. [DOI] [PubMed] [Google Scholar]
  51. Santis G., Osborne L., Knight R. A., Hodson M. E. Independent genetic determinants of pancreatic and pulmonary status in cystic fibrosis. Lancet. 1990 Nov 3;336(8723):1081–1084. doi: 10.1016/0140-6736(90)92566-z. [DOI] [PubMed] [Google Scholar]
  52. Sato Hiroe, Grutters Jan C., Pantelidis Panagiotis, Mizzon A. Neil, Ahmad Tariq, Van Houte Arend-Jan, Lammers Jan-Willem J., Van Den Bosch Jules M. M., Welsh Kenneth I., Du Bois Roland M. HLA-DQB1*0201: a marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Respir Cell Mol Biol. 2002 Oct;27(4):406–412. doi: 10.1165/rcmb.4782. [DOI] [PubMed] [Google Scholar]
  53. Taouil Karima, Hinnrasky Jocelyne, Hologne Coralie, Corlieu Pascal, Klossek Jean-Michel, Puchelle Edith. Stimulation of beta 2-adrenergic receptor increases cystic fibrosis transmembrane conductance regulator expression in human airway epithelial cells through a cAMP/protein kinase A-independent pathway. J Biol Chem. 2003 Mar 5;278(19):17320–17327. doi: 10.1074/jbc.M212227200. [DOI] [PubMed] [Google Scholar]
  54. Turner M. W. The role of mannose-binding lectin in health and disease. Mol Immunol. 2003 Nov;40(7):423–429. doi: 10.1016/s0161-5890(03)00155-x. [DOI] [PubMed] [Google Scholar]
  55. Wojnarowski C., Frischer T., Hofbauer E., Grabner C., Mosgoeller W., Eichler I., Ziesche R. Cytokine expression in bronchial biopsies of cystic fibrosis patients with and without acute exacerbation. Eur Respir J. 1999 Nov;14(5):1136–1144. doi: 10.1183/09031936.99.14511369. [DOI] [PubMed] [Google Scholar]
  56. Zielenski J., Corey M., Rozmahel R., Markiewicz D., Aznarez I., Casals T., Larriba S., Mercier B., Cutting G. R., Krebsova A. Detection of a cystic fibrosis modifier locus for meconium ileus on human chromosome 19q13. Nat Genet. 1999 Jun;22(2):128–129. doi: 10.1038/9635. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press

RESOURCES