I think the opening question was ‘how long will it be when we find a cure for CF and no more deaths will result from CF’. A cure, for the living CFers most probably will involve something to mitigate what results in thick mucus. For CFers that have pulmonary presentations the root of all their problems stems from production of mucus made thick by high a concentration of salt. A normal lung secretes mucus from its mucus membrane, which is nearly water thin. The mucus keeps the lungs moist, and it catches everything our nasal system doesn’t catch. In the mucus catch are pathogens, foreign bodies like pollen and mold spores. There is a network of hair cells, or cilia that are designed to move unwanted debris by a wave action of the cilia up and out of the lungs including most of the mucus. Thick mucus overwhelms the alveoli and at best interferes with oxygen transport and at worst collapses the alveoli sac. On some scale of viscosity, the normal mucus transport is either slowed or stopped resulting in both an unhealthy medium for the lungs and an opportunistic medium for infection. And just as a very viscous mucus through multiple pathogen infections, the lung becomes nonfunctional. Apply the same logic to the nasal/sinus system and the infection fighting mucus, catches its quarry of microbes and allergens and right along with the host mucus, it stays. Although it would be disfiguring, we can technically live without a nasal system, non functional lungs result in death. In the GI tract, any and all sources of mucus can be similarly thick this time instead of blocking off effective oxygenation, the transport of digestive enzymes from the pancreas, bile and sticky walled intestines and bowels interfere with nutrition. For the uninitiated, an intestinal blockage, bowel blockage including constipation can be fatal. If caught in time a blockage can be removed. But auto digestion of the pancreas can result in organ death very quickly for newborns, and can be living hell with indescribable pain for anybody going through it.
<strong>Why don’t we have the mucus equivalent of a blood thinner? </strong>That could go a long way if it, like my analog of a blood thinner, thins all mucus, everywhere in the body. I do not have an answer to this, and for sure it would pay off in spades, eliminating a host of diseases not remotely related to CF.
CF is a genetic disorder specifically it is a monogenetic disorder meaning all our misery is a malfunction of a single gene. It is not a disease and it cannot be cured in conventional terms. It isn’t common knowledge, but in an odd way, CF has one parallel with Mendel’s pea plants. It is a seminal discovery, and one of the first genes that is understood at a level, few genetic disorders have enjoyed. Being monogenetic like Mendel’s choice of peas to determine dominant and recessive genetic characteristics, if almost any other plant or even higher life forms would have yielded something requiring a super computer to figure out.
Like war, in order to win, the first rule is to know your enemy. What help is it to continue to tease more and more mutations out of the CFTR gene? We seem to know less as we learn more. Why would an army of well equipped labs staffed with scientists continue to hammer on this disorder with little promise of future profit? The short answer is it is a perfect genetic disorder to learn the big lessons and make the big discoveries that apply to any and most likely all disorders and diseases. Many genetic therapies have been tried as a result of the CFTR gene mutation. I so far has been too little for too much side effects and of course cost. But the CFTR gene, mutation or not presents all the fundamental problems in effective gene therapy. We need a way of harvesting and “growing” large amounts of the healthy gene. We need a vector to deliver it to every cell’s nucleus and further, to deliver it to the correct spot on the correct chromosome. Finally we need something to activate this gene. This will probably result in a few Nobel Prizes, but considering how vast the genetic playground is, having a model to work on and develop tools for is encapsulated in CF genetics. Yes we now have one CF drug that affects 4% of the CF community. If you were in that 4% you would be yelling hosannas and turning cartwheels. If the sum of my life was to ‘cure’ 4% of 30,000 people I would die with a big wide smile.
I see a lot of promising work on a genetic resolution to all CF sufferers. We may have to settle for some time with mutation specific genetically based drugs, but as many people who are taking the steps it took to affect 551 mutation, imagine the impact when DeltaDF508 has a specific drug. I fully expect a panacea genetically based drug in my lifetime. I am 62 and if all goes well, I will see 75, but no longer. So this is my official prognostication of 13-15 years to a panacea CF genetically based drug. If I am wrong, it will be from earlier rather than later discovery.