Forskolin induced swelling (FIS) assay in intestinal organoids to guide eligibility for compassionate use treatment in a CF patient with a rare genotype.

B L Aalbers, J E Brunsveld, C K van der Ent, J C van den Eijnden, J M Beekman, H G M Heijerman

Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society 2022 Mar

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Forskolin-induced swelling of patient-derived organoids has been used to measure patient-specific CFTR function and CFTR modulator response. We present a case where CFTR function assessment in intestinal organoids was decisive for a patients' acceptance to a compassionate use program. A 56 years old female with cystic fibrosis compound heterozygous for F508del and a rare CFTR allele (c.3717+5G>T) experienced rapid clinical deterioration. The forskolin-induced swelling assay on her rectal organoids was used to confirm that the rare mutation is a minimal residual function mutation, and that other CFTR modulators would not likely be effective. Based on these two criteria and her clinical status, she was accepted for compassionate use of elexacaftor/tezacaftor/ivacaftor and showed improvement in all clinical parameters. This reports describes a first example that intestinal organoids were used to identify a previously unknown CFTR mutation as a minimal function mutation. The individual FIS-based definition of minimal residual function, response to ele/tez/iva and/or lack of response to other CFTR modulating drugs, may thus provide a tool for access to ele/tez/iva treatment for people with rare genotypes. Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Citation

B L Aalbers, J E Brunsveld, C K van der Ent, J C van den Eijnden, J M Beekman, H G M Heijerman. Forskolin induced swelling (FIS) assay in intestinal organoids to guide eligibility for compassionate use treatment in a CF patient with a rare genotype. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2022 Mar;21(2):254-257