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Wee WB, Kinghorn B, Davis SD, Ferkol TW, Shapiro AJ. Primary Ciliary Dyskinesia. Pediatrics 2024; 153:e2023063064. [PMID: 38695103 PMCID: PMC11153322 DOI: 10.1542/peds.2023-063064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 06/02/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetic disease characterized by dysfunctional motile cilia and abnormal mucociliary clearance, resulting in chronic sino-oto-pulmonary disease, neonatal respiratory distress, subfertility, and organ laterality defects. Over the past 2 decades, research and international collaborations have led to an improved understanding of disease prevalence, classic and variable phenotypes, novel diagnostics, genotype-phenotype correlations, long term morbidity, and innovative therapeutics. However, PCD is often underrecognized in clinical settings and the recent analyses of genetic databases suggest that only a fraction of these patients are being accurately diagnosed. Knowledge of significant advancements, from pathophysiology to the expanded range of clinical manifestations, will have important clinical impacts. These may include increasing disease recognition, improving diagnostic testing and management, and establishing an adequate pool of affected patients to enroll in upcoming clinical therapeutic trials. The objective of this state-of-the-art review is for readers to gain a greater understanding of the clinical spectrum of motile ciliopathies, cutting-edge diagnostic practices, emerging genotype-phenotype associations, and currently accepted management of people with PCD.
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Affiliation(s)
- Wallace B. Wee
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - BreAnna Kinghorn
- University of Washington, School of Medicine, Pediatrics, Seattle, Washington
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Thomas W. Ferkol
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Adam J. Shapiro
- McGill University Health Centre Research Institute, Montreal Children’s Hospital, Montreal, Quebec, Canada
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Kaspy KR, Dell SD, Davis SD, Ferkol TW, Rosenfeld M, Sagel SD, Milla C, Olivier KN, Barber AT, Wee W, Lin FC, Li L, Rampakakis E, Zariwala MA, Knowles MR, Leigh MW, Shapiro AJ. Situs Ambiguus Is Associated With Adverse Clinical Outcomes in Children With Primary Ciliary Dyskinesia. Chest 2024; 165:1070-1081. [PMID: 38072392 PMCID: PMC11110675 DOI: 10.1016/j.chest.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/01/2023] [Accepted: 12/03/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare disorder of motile cilia associated with situs abnormalities. At least 12% of patients with PCD have situs ambiguus (SA), including organ laterality defects falling outside normal arrangement (situs solitus [SS]) or mirror image inversion (situs inversus totalis [SIT]). RESEARCH QUESTION Do patients with PCD and SA achieve worse clinical outcomes compared with those with SS or SIT? STUDY DESIGN AND METHODS This cross-sectional, multicenter study evaluated participants aged 21 years or younger with PCD. Participants were classified as having SA, including heterotaxy, or not having SA (SS or SIT). Markers of disease severity were compared between situs groups, adjusting for age at enrollment and severe CCDC39 or CCDC40 genotype, using generalized linear models and logistic and Poisson regression. RESULTS In 397 participants with PCD (mean age, 8.4 years; range, 0.1-21), 42 patients were classified as having SA, including 16 patients (38%) with complex cardiovascular malformations or atrial isomerism, 13 patients (31%) with simple CVM, and 13 patients (31%) without cardiovascular malformations. Of these, 15 patients (36%) underwent cardiac surgery, 24 patients (57%) showed an anatomic spleen abnormality, and seven patients (17%) showed both. The remaining 355 participants did not have SA, including 152 with SIT and 203 with SS. Overall, 70 participants (17%) harbored the severe CCDC39 or CCDC40 genotype. Compared with participants without SA, those with SA showed lower median BMI z scores (P = .03), lower FVC z scores (P = .01), and more hospitalizations and IV antibiotic courses for acute respiratory infections during the 5 years before enrollment (P < .01). Participants with cardiovascular malformations requiring surgery or with anatomic spleen abnormalities showed lower median BMI z scores and more hospitalizations and IV therapies for respiratory illnesses compared with participants without SA. INTERPRETATION Children with PCD and SA achieve worse nutritional and pulmonary outcomes with more hospitalizations for acute respiratory illnesses than those with SS or SIT combined. Poor nutrition and increased hospitalizations for respiratory infections in participants with SA and PCD are associated with cardiovascular malformations requiring cardiac surgery, splenic anomalies, or both. TRIAL REGISTRY ClinicalTrials.gov; Nos.: NCT02389049 and NCT00323167; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kimberley R Kaspy
- McGill University Health Centre Research Institute, Montreal Children's Hospital, Montreal, QC
| | - Sharon D Dell
- BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - Stephanie D Davis
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Thomas W Ferkol
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA
| | - Scott D Sagel
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Carlos Milla
- Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Kenneth N Olivier
- Department of Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA
| | - Wallace Wee
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Lang Li
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Emmanouil Rampakakis
- McGill University Health Centre Research Institute, Montreal Children's Hospital, Montreal, QC
| | - Maimoona A Zariwala
- Department of Pathology/Lab Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Adam J Shapiro
- McGill University Health Centre Research Institute, Montreal Children's Hospital, Montreal, QC.
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Barber AT, Liptzin DR, Gower WA, Hinds DM. Pediatric Pulmonology 2022 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:2719-2724. [PMID: 37493100 DOI: 10.1002/ppul.26603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
The field of rare and diffuse pediatric lung disease continues to evolve and expand rapidly as clinicians and researchers make advancements in the diagnosis and treatment of children's interstitial and diffuse lung disease, non-cystic fibrosis bronchiectasis, and primary ciliary dyskinesia. Papers published on these topics in Pediatric Pulmonology and other journals in 2022 describe newly recognized disorders, elucidate disease mechanisms and courses, explore potential biomarkers, and assess novel treatments. In this review, we will discuss these important advancements and place them in the context of existing literature.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Deborah R Liptzin
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Daniel M Hinds
- Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA
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