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Genetic analysis in cystic fibrosis (CF) is a difficult task. Within the many causes of variability and uncertainty, a major determinant is poor knowledge of the functional effect of most DNA variants of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene. In turn, knowledge of the effect of a CFTR variant has dramatic diagnostic, prognostic and, in the era of CF precision medicine, also therapeutic consequences. One of the most challenging CFTR variants is the (TG)mTn haplotype, which has variable functional effect and controversial clinical consequences. The exact quantification of the anomalous splicing of CFTR exon 10 (in the HGVS name, exon 9 in the legacy name) and, consequently, of the residual wild-type functional CFTR mRNA, should be mandatory in clinical assessment of patients with potentially pathological haplotype of this tract. Here, we present a real time-based assay for the quantification of the proportion of exon 10+/exon 10&minus, CFTR mRNA, starting from nasal brushing. Our assay proved rapid, economic and easy to perform. Specific primers used for this assay are either disclosed or commercially available, allowing any laboratory to easily perform it. A simplified analysis of the data is provided, facilitating the interpretation of the results. This method helps to enhance the comprehension of the genotype&ndash, phenotype relationship in CF and CFTR-related disorders (CFTR-RD), crucial for the diagnosis, prognosis and personalized therapy of CF.

Two novel and related pathogenic variants of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene were structurally and functionally characterized. These alterations have not been previously described in literature. Two patients with diagnosis of Cystic Fibrosis (CF) based on the presence of one mutated allele, p.Phe508del, pathological sweat test and clinical symptoms were studied. To complete the genotypes of both patients, an extensive genetic and functional analysis of the CFTR gene was performed. Extensive genetic characterization confirmed the presence of p.Phe508del pathogenic variant and revealed, in both patients, the presence of an insertion of part of intron 10 in intron 9 of the CFTR gene, within the (TG)m repeat, with a variable poly-T stretch. The molecular lesions resulted to be very similar in both patients, with only a difference in the number of T in the poly-T stretch. The functional characterization at RNA level revealed a complete anomalous splicing, without exon 10, from the allele with the insertion of both patients. Consequently, the alleles with the insertions are expected not to contribute to the formation of a functional CFTR protein. Molecular and functional features of these alterations are compatible with the definition of novel CF-causing variants of the CFTR gene. This also allowed the completion of the genetic characterization of both patients.

Cystic fibrosis (CF; OMIM 602421, see OMIM link in the website section) is the most common lethal genetic disease of the Caucasian population, with a very variable prevalence, from 1/25000 to 1/900, depending on the geographical region (O'Sullivan & Freedman, 2009; Riordan, 2008). CF is caused by mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene (Kerem et al., 1989; Rommens et al., 1989; Zielenski et al., 1991) (see Ensembl link in the website section), which encodes for a transmembrane multifunctional protein expressed mainly in epithelia (Trezise et al., 1993a; Yoshimura et al., 1991b) but also in several cell types of nonepithelial origin (Yoshimura et al., 1991a). It is an ATPand cAMP-dependent Clchannel with the main function performed at the apical membrane of epithelial cells. This function is the Clion secretion in the colon and airways, or its reabsorption in sweat glands (Riordan, 2008; Vankeerberghen et al., 2002). In the lung, the main targeted organ of CF, an additional crucial function performed by CFTR is the regulation of the epithelial Na+ channel (ENaC) activity. The exact mechanism of CFTR – ENaC interaction is not completely understood and contrasting evidences exist about the role of ENaC in CF. The most reliable vision of the basic defect is that, in the airway epithelia of CF patients, a CFTR deficiency causes an anomalous dual ion transport associated to an altered water absorption (Mall et al., 1998; Stutts et al., 1995; Berdiev et al., 2009) that, in turn, leads to sticky mucus and impaired mucociliary clearance (Donaldson et al., 2002; Matsui et al., 1998). The immune response greatly contributes to increased mucus viscosity through bacterial lysis and DNA release, as well as through immune cell death in the airways. Bacterial infections and inflammation produce bronchial obstruction, bronchiectasis, atrophy and, eventually, lung insufficiency. A probably non-exhaustive list of other CFTR functions includes: the bicarbonate secretion (Kim & Steward, 2009); the regulation of several other ionic channels and of the ion composition of intracellular compartments, as well the control of intracellular vesicle transport (Vankeerberghen et al., 2002); antibacterial activity exerted by epithelial cells (Pier et al., 1997; Schroeder et al., 2002) and macrophages (Del Porto et al., 2011; Di et al., 2006); maintenance of a correct level of hydration, essential for a physiologic development of male reproductive apparatus (Dube et al., 2008; Patrizio & Salameh, 1998; Trezise et al., 1993a), testis, pancreas, liver and intestine (O'Sullivan & Freedman, 2009; Ratjen & Doring, 2003); critical role in

Background: Automated DNA sequencing produces large amounts of data that need to be analyzed by appropriate software. Personalization of software can be a difficult and timeconsuming task, especially if a large number of mutations have to be analyzed. Methods: The Applied BioSystems SeqScape software, based on the KB basecaller algorithm, is a versatile tool that can be used for mutational analysis and for data quality assessment of sequences belonging to any gene of interest. Using this software we analyzed over 1400 sequences of CFTR exons and adjacent intronic zones, representing over 500,000 bases. Results: We present an up to date specific template and a linked set of instructions for automated labeling of all point mutations and polymorphisms of the CFTR gene, whose mutations cause cystic fibrosis (the most common genetic disease among Caucasian individuals). We also describe our refined software settings for mutational analysis, in order to keep to a minimum the need of manual validation. Conclusions: The use of our template greatly simplifies the mutational analysis of the CFTR gene, reducing human intervention. In our opinion, it might not only be useful to researchers that already perform CFTR mutational analysis by sequencing methods but it should also improve the approach in those laboratories that already use ABI PRISM instrumentation for a limited mutational analysis of the CFTR gene. Similar mutational templates can also be used for other disease causing genes, thus improving molecular genetics protocols.

We have assembled two BAC vectors containing a single fragment spanning the entire CFTR locus and including the upstream and downstream regions. The two vectors differ in size of the upstream region, and were recovered in Escherichia coli, with intact BAC DNAs prepared for structural and functional analyses. Sequence analysis allowed precise mapping of the inserts. We show that the CFTR gene was wild type and is categorized as the most frequent haplotype in Caucasian populations, identified by the following polymorphisms: (GATT)7 in intron 6a; (TG)11T7 in intron 8; V470 at position 470. CFTR expression and activity were analyzed in model cells by RT-PCR, quantitative real-time PCR, western blotting, indirect immunofluorescence and electrophysiological methods, which show the presence of an active CFTR Cl − channel. Finally, and supporting the hypothesis that CFTR functions as a receptor for Pseudomonas aeruginosa, we show that CFTR-expressing cells internalized more bacteria than parental cells that do not express CFTR. Overall, these data demonstrate that the BAC vectors contain a functional CFTR fragment and have unique features, including derivation from a single fragment, availability of a detailed genomic map and the possibility to use standard extraction procedures for BAC DNA preparations.