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The secretions of the exocrine pancreas provide for digestion of a meal into components that are then available for processing and absorption by the intestinal epithelium. Without the exocrine pancreas, malabsorption and malnutrition result. This chapter describes the cellular participants responsible for the secretion of digestive enzymes and fluid that in combination provide a pancreatic secretion that accomplishes the digestive functions of the gland. Key cellular participants, the acinar cell and the duct cell, are responsible for digestive enzyme and fluid secretion, respectively, of the exocrine pancreas. This chapter describes the neurohumoral pathways that mediate the pancreatic response to a meal as well as details of the cellular mechanisms that are necessary for the organ responses, including protein synthesis and transport and ion transports, and the regulation of these responses by intracellular signaling systems. Examples of pancreatic diseases resulting from dysfunction in cellular mechanisms provide emphasis of the importance of the normal physiologic mechanisms.

Pancreas. --- Pancreatic acinar cells. --- Pancreas, Exocrine. --- Pancreas --- Secretion --- Digestive enzymes --- Acinar cell --- Duct cell --- Digestion --- Centroacinar cell --- Cholecystokinin --- Secretin --- Endoplasmic reticulum --- Zymogens --- Zymogen granule --- Condensing vacuole --- Lysosome --- Unfolded protein response --- Cystic fibrosis --- Trypsinogen --- Lipase --- Amylase

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The introduction and widespread implementation of newborn bloodspot screening (NBS) for cystic fibrosis (CF) has offered earlier diagnosis and better outcomes for children with CF in many countries of the world. It represents a paradigm shift in the diagnostic pathway for these families. In contrast to a clinical diagnosis, infants are now referred for diagnostic testing after a positive NBS result. The introduction of NBS has enabled the provision of early appropriate treatment to prevent the manifestations of the disease. In the near future, early diagnosis will facilitate the prompt use of new CFTR modulator therapies that correct the basic underlying molecular defect. NBS for CF has been a global success but continues to raise questions with many varied approaches and the development of new technologies, in particular the ability to undertake extensive gene examination. Which is the best protocol to achieve high sensitivity and specificity, and how to evaluate and manage infants with inconclusive diagnosis are all subjects of ongoing discussion. It is also open to question: what is the best approach to informing and counselling the parents about a positive or inconclusive NBS result? These questions are not easy to answer and require a balanced solution that reflects the local health care system and may appropriately result in different answers around the globe. The articles in this book try to answer these questions and give an overview of the current state of knowledge in NBS for CF.

newborn screening --- immunoreactive trypsin(ogen) --- dried blood spot --- radioimmunoassay --- DNA --- cystic fibrosis --- incidence --- malnutrition --- cost --- health policy --- CF transmembrane conductance regulator-related metabolic syndrome --- CF screen positive --- inconclusive diagnosis --- DNA analysis --- next generation sequencing --- extended genetic analysis --- presumptive diagnosis --- sweat test --- parental information --- newborn bloodspot screening --- psychological impact --- biochemical screening --- pancreatitis associated protein --- immunoreactive trypsinogen --- cystic fibrosis screen positive --- inconclusive diagnosis (CFSPID) --- bioethics --- newborn screen --- target disorder --- missed case --- sensitivity --- CFSPID --- immunoreactive trypsin --- meconium ileus --- diagnosis --- therapy --- prognosis --- n/a

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Summary of Genes. Thirty years ago, the gene responsible for cystic fibrosis (CF), a recessive genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene, was identified. This progress has considerably changed our understanding of the pathophysiology of CF and has paved the way for the development of novel and specific therapies for the disease. The CFTR gene contains 27 exons and is characterized by a frequent three base pair deletion of the p.Phe508del. As a result of collaborative work, today more than 2000 mutations have been reported in the gene, and their impact on protein function is now more evident and useful in designing new strategies to correct the gene defect. The field of gene therapy, as illustrated by Ziying Yan in this book, has worked on identifying an efficient vector system for the delivery of the wild-type CFTR gene to the lung. At the same time, animal models have been developed in mice, rats, rabbits, zebrafish, ferrets, and pigs to establish the efficacity of gene delivery. These animals are also of the utmost importance in testing new molecules as modulators or correctors to improve the CFTR lung function. During the last three decades, the epidemiology of CF has dramatically changed, as today cystic fibrosis is now a chronic adult pulmonary disease.

Medicine --- cystic fibrosis --- Staphylococcus aureus --- superantigen --- enterotoxin gene cluster --- MRSA --- exosomes --- microvesicles --- lung --- primary cells --- newborn screening --- trypsinogen --- CFTR gene --- next generation sequencing --- health policy --- rAAV2/HBoV1 --- baculovirus --- insect cells --- lung microbiome --- metagenomics --- gut–lung axis --- Cystic fibrosis --- CFTR --- transcriptomics --- proteostasis --- small molecules --- drug development --- common and new pathogenic variants --- ethnic Russian population --- gene therapy --- cyclophosphamide --- transient immunosuppression --- incidence --- survival --- genotype-phenotype correlations --- health policies --- CFTR modulators --- human nasal epithelial cells --- organoids --- biomarker --- functional assay --- pre-clinical in vitro models --- CFTR-related disorders --- molecular diagnosis --- CFTR variants --- Next Generation Sequencing (NGS) --- disease liability --- interpretation --- penetrance --- genotype-guided therapy --- miRNA --- airway basal cell --- lentivirus --- cystic fibrosis --- Staphylococcus aureus --- superantigen --- enterotoxin gene cluster --- MRSA --- exosomes --- microvesicles --- lung --- primary cells --- newborn screening --- trypsinogen --- CFTR gene --- next generation sequencing --- health policy --- rAAV2/HBoV1 --- baculovirus --- insect cells --- lung microbiome --- metagenomics --- gut–lung axis --- Cystic fibrosis --- CFTR --- transcriptomics --- proteostasis --- small molecules --- drug development --- common and new pathogenic variants --- ethnic Russian population --- gene therapy --- cyclophosphamide --- transient immunosuppression --- incidence --- survival --- genotype-phenotype correlations --- health policies --- CFTR modulators --- human nasal epithelial cells --- organoids --- biomarker --- functional assay --- pre-clinical in vitro models --- CFTR-related disorders --- molecular diagnosis --- CFTR variants --- Next Generation Sequencing (NGS) --- disease liability --- interpretation --- penetrance --- genotype-guided therapy --- miRNA --- airway basal cell --- lentivirus