Non-cystic fibrosis bronchiectasis (NCFBE) is a clinical syndrome characterized by abnormal dilatation of the airways, airflow obstruction, persistent cough, excessive sputum production and recurrent lung infections. In terms of pathophysiology, airway dilatation and other features are associated with impaired mucociliary clearance and failure to adequately expel bacteria and mucus secretions from the airways. These events contribute to persistent infection, inflammation, and further progressive airway damage, leading to diminished lung function and eventually may cause respiratory failure and death. The pathogenesis of NCFBE is complex, poorly understood, and is likely to vary depending on the underlying etiology and important modifying factors.~Trikafta is approved for patients with cystic fibrosis (CF) carrying at least one copy of the common F508del variant or a number of other cystic fibrosis transmembrane conductance regulator (CFTR) mutations. Trikafta is a combination of three CF drugs, elexacaftor, ivacaftor, and tezacaftor, that helps CFTR proteins work more effectively. Patients with common forms of CF typically exhibit a robust pulmonary benefit from Trikafta within several days to a few weeks of initiating treatment.~NCFBE is clinically and pathologically similar to certain features of cystic fibrosis lung disease. Patients with NCFBE are not approved for Trikafta, and do not have access to the drug. Based on a considerable body of evidence, the researchers believe: 1) cutaneous punch biopsy material, differentiated to airway epithelium, can be used to identify patients with NCFBE likely to benefit from drugs such as Trikafta, and 2) many patients with NCFBE have a disease likely to exhibit significant clinical improvement when treated with a drug such as Trikafta that activates CFTR-dependent ion transport, although neither of those notions has been adequately tested or proposed previously.~This study is an open-label, single center trial of orally administered elexacaftor, tezacaftor and ivacaftor (Trikafta) that will enroll 30 patients with NCFBE. Study participants will have one known CFTR mutation and/or mildly elevated sweat chloride measurements. In this matter, the study will specifically and prospectively test induced pluripotent stem (iPS) cells taken from patients with NCFBE to determine in vitro thresholds for predicting CFTR rescue in vivo. Using iPS cells differentiated to exhibit a respiratory epithelial phenotype, this study will determine whether the cells can be used to predict FEV1 response among individuals with NCFBE who receive Trikafta.
Study participants with non-cystic fibrosis bronchiectasis will be given Trikafta for four weeks. The researchers will monitor clinical endpoints, quality of life, and weight. Additionally, cutaneous punch biopsy material will be collected from each participant to test cellular response to Trikafta.