1
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Zhao T, Huang X, Chen W, Gao H, Feng Z, Tan C, Sun J, Ma X, Yan W, Sheng W, Huang G. Clinical implications of respiratory ciliary dysfunction in heterotaxy patients with congenital heart disease: elevated risk of postoperative airway complications. Front Cardiovasc Med 2024; 10:1333277. [PMID: 38292451 PMCID: PMC10825948 DOI: 10.3389/fcvm.2023.1333277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Objective Cardiac surgery in Congenital Heart Disease-Heterotaxy (CHD-HTX) patients often leads to increased postoperative airway complications. Abnormal respiratory ciliary function, resembling primary ciliary dyskinesia, has been observed. We expanded the sample size by retrospectively reviewing Ciliary Dysfunction (CD) in CHD-HTX patients to verify the increased risk of post-surgical respiratory complications. Methods We conducted a retrospective review of 69 CHD-HTX patients undergoing cardiac surgery, assessing abnormal respiratory function using nasal nitric oxide (nNO) levels and nasal ciliary motion observed in video microscopy. Data collected included demographics, surgical details, postoperative complications, length of stay, ICU hours, salvage procedures, intubation duration, and mortality. Results The CD and no-CD cohorts exhibited notable similarities in risk adjustment in Congenital Heart Surgery-1 (RACHS-1) risk categories, age at the time of surgery, and the duration of follow-up evaluations. We observed a trend toward an increased length of post-operative stay in the CD group (15.0 vs. 14.0; P = 0.0017). CHD-HTX patients with CD showed significantly higher rates of respiratory complications (70% vs. 44.4%; P = 0.008). There were no notable variances observed in postoperative hospitalization duration, mechanical ventilation period, or surgical mortality. Conclusion Our findings suggest that CHD-HTX patients with CD may face an elevated risk of respiratory complications. These results offer guidance for perioperative management and serve as a reference for further pathological studies.
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Affiliation(s)
- Tingting Zhao
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Xianghui Huang
- Fujian Provincial Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital Affiliated to Children's Hospital of Fudan University, Shanghai, Xiamen, China
| | - Weicheng Chen
- Children's Hospital Affiliated to Fudan University, Shanghai, China
| | - Han Gao
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Zhiyu Feng
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Chaozhong Tan
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Jingwei Sun
- Bengbu First People's Hospital Affiliated to Bengbu Medical University, Hefei, Anhui, China
| | - Xiaojing Ma
- Children's Hospital Affiliated to Fudan University, Shanghai, China
| | - Weili Yan
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei Sheng
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases, Chinese Academy of Medical Sciences, Shanghai, China
| | - Guoying Huang
- Children's Hospital Affiliated to Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases, Chinese Academy of Medical Sciences, Shanghai, China
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2
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Paternò S, Pisani L, Zanconato S, Ferraro VA, Carraro S. Role of Nasal Nitric Oxide in Primary Ciliary Dyskinesia and Other Respiratory Conditions in Children. Int J Mol Sci 2023; 24:16159. [PMID: 38003348 PMCID: PMC10671569 DOI: 10.3390/ijms242216159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Nitric oxide (NO) is produced within the airways and released with exhalation. Nasal NO (nNO) can be measured in a non-invasive way, with different devices and techniques according to the age and cooperation of the patients. Here, we conducted a narrative review of the literature to examine the relationship between nNO and some respiratory diseases with a particular focus on primary ciliary dyskinesia (PCD). A total of 115 papers were assessed, and 50 were eventually included in the review. nNO in PCD is low (below 77 nL/min), and its measurement has a clear diagnostic value when evaluated in a clinically suggestive phenotype. Many studies have evaluated the role of NO as a molecular mediator as well as the association between nNO values and genotype or ciliary function. As far as other respiratory diseases are concerned, nNO is low in chronic rhinosinusitis and cystic fibrosis, while increased values have been found in allergic rhinitis. Nonetheless, the role in the diagnosis and prognosis of these conditions has not been fully clarified.
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Affiliation(s)
| | | | | | | | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women’s and Children’s Health Department, University of Padova, 35128 Padova, Italy; (S.P.); (L.P.); (S.Z.); (V.A.F.)
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3
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Mrkić Kobal I, Turkalj M, Plavec D. Nasal Nitric Oxide in Children: A Review of Current Outreach in Pediatric Respiratory Medicine. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1671. [PMID: 37892334 PMCID: PMC10605182 DOI: 10.3390/children10101671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/23/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
Nasal nitric oxide (nNO) is a gas synthesized by the inducible and constitutive NO synthase (NOS) enzyme in the airway cells of the nasal mucosa. Like lung nitric oxide, it is thought to be associated with airway inflammation in various respiratory diseases in children. The aim of our review was to investigate the current state of use of nNO measurement in children. A comprehensive search was conducted using the Web of Science and PubMed databases specifically targeting publications in the English language, with the following keywords: nasal NO, children, allergic rhinitis, chronic rhinosinusitis, acute rhinosinusitis, primary ciliary dyskinesia (PCD), and cystic fibrosis (CF). We describe the use of nNO in pediatric allergic rhinitis, chronic rhinosinusitis, acute rhinosinusitis, PCD, and CF based on the latest literature. nNO is a noninvasive, clinically applicable test for use in pediatric allergic rhinitis, chronic rhinosinusitis, acute rhinosinusitis, PCD, and CF. It can be used as a complementary method in the diagnosis of these respiratory diseases and as a monitoring method for the treatment of allergic rhinitis and acute and chronic rhinosinusitis.
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Affiliation(s)
- Iva Mrkić Kobal
- Outpatient Clinic for Sick Children Dr. Sabol, 10000 Zagreb, Croatia;
- Faculty of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Mirjana Turkalj
- Faculty of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Children’s Hospital Srebrnjak, 10000 Zagreb, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Davor Plavec
- Faculty of Medicine, JJ Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Prima Nova, Healthcare Institution, 10000 Zagreb, Croatia
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4
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Beydon N, Ferkol T, Harris AL, Colas M, Davis SD, Haarman E, Hogg C, Kilbride E, Kouis P, Kuehni CE, Latzin P, Marangu D, Marthin J, Nielsen KG, Robinson P, Rumman N, Rutter M, Walker W, Lucas JS. An international survey on nasal nitric oxide measurement practices for the diagnosis of primary ciliary dyskinesia. ERJ Open Res 2022; 8:00708-2021. [PMID: 35386825 PMCID: PMC8977594 DOI: 10.1183/23120541.00708-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
Nasal nitric oxide (nNO) measurements are routinely used in the assessment of patients suspected to have primary ciliary dyskinesia (PCD), but recommendations for performing such measurements have not focused on children and do not include all current practices. To guide the development of a European Respiratory Society-supported technical standard for nNO measurements in children, an international online survey was conducted to better understand current practices for measuring nNO among providers involved in PCD diagnostics.Seventy-eight professionals responded, representing 65 centres across 18 countries, mainly located in Europe and North America. Nearly all centres measured nNO in children and more than half of them performed measurements before 5-years of age. The test was often postponed in children with signs of acute airway infection. In Europe, the electrochemical technique was more frequently used than chemiluminescence. A similar proportion of centres performed measurements during exhalation against a resistance (49/65) or during tidal breathing (50/65) with 15 centres using only exhalation against a resistance and 15 centres using only tidal breathing. The cut-off values used to discriminate PCD was consistent across centres using chemiluminescence analyzers and these centres reported results as an output (nL.min−1). However, cut-off values were highly variable across centres using electrochemical devices, and nNO concentrations were typically reported as ppb.This survey represents the first to determine real-world use of nNO measurements worldwide and revealed remarkable variability in methodology, equipment, and interpretation. These findings will be useful to standardise methods and training.
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5
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Buechel F, Usemann J, Aline A, Salfeld P, Moeller A, Jung A. Feasibility of nasal NO screening in healthy newborns. Pediatr Pulmonol 2022; 57:231-238. [PMID: 34570949 PMCID: PMC9292553 DOI: 10.1002/ppul.25702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nasal nitric oxide (nNO) measurement is recommended as a first line screening test for primary ciliary dyskinesia (PCD). While reliable velum- and non-velum-closure techniques exist for preschool children and older individuals, no data are available for neonates. AIMS To determine feasibility of nNO screening and nNO concentration in healthy newborns in the first week of life. METHODS Nasal NO was analyzed in tidal breathing during natural sleep using a CLD-88 sp NO analyzer (chemoluminescence sensor) and a NIOX MINO (electrochemical sensor). Test success and nNO concentration were determined and compared between the two devices. RESULTS Nasal NO was measured in 62 healthy neonates within the first week of life. Feasibility of nNO measurement was 100% for at least one nostril and 85.5% for both nostrils using the chemoluminescence device, but significantly lower with the electrochemical device (85.5% and 53.2%; p < .001). Median nNO concentration was 38 ppb (interquartile range, 27-55; range, 9-100) with the ECOMEDICS device and 23 (15-33, 8-59) with the NIOX MINO (p < .001), with a trend towards higher values for older subjects. None of the subjects exceeded nNO levels of 100 ppb. CONCLUSION Measurement of nNO using a chemoluminescence device is highly feasible in newborns during natural sleep. However, nNO levels are considerably lower compared to the published data for older individuals and in the range of a PCD reference group of infants between 4 and 8 weeks of age, potentially resulting in a great overlap with subjects with PCD in this age group. Therefore, screening for PCD using nasal NO might not be useful in the first week of life. Upon clinical suspicion, other diagnostic tests such as high-speed video analysis of the cilia should be applied.
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Affiliation(s)
- Flurina Buechel
- Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich
| | - Jakob Usemann
- Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich.,University Children's Hospital Basel, Basel, Switzerland
| | - A Aline
- Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich
| | - Peter Salfeld
- Kantonsspital Muensterlingen, Münsterlingen, Switzerland
| | - Alexander Moeller
- Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich
| | - Andreas Jung
- Division of Respiratory Medicine & Children's Research Centre, University Children's Hospital Zurich
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6
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Beydon N, Tamalet A, Escudier E, Legendre M, Thouvenin G. Breath-holding and tidal breathing nasal NO to screen children for Primary Ciliary Dyskinesia. Pediatr Pulmonol 2021; 56:2242-2249. [PMID: 33860637 DOI: 10.1002/ppul.25432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Abstract
Nasal nitric oxide (nNO) measurement is recommended to screen for Primary Ciliary Dyskinesia (PCD) in subjects with suggestive history and symptoms. Clinical use of alternative methods (i.e., breath-hold [BH], tidal breathing [TB]) in children unable to perform the gold standard slow Exhalation against a Resistance (ER) method has not been sufficiently evaluated. We extracted retrospectively (2013-2019) 454 files (374 subjects) containing nNO results. Median [IQR] age at inclusion was 7.0 [4.7-11.0] years, 105 (28.1%) children were younger than 5 years. ER or BH methods were more frequently mastered by children older than 5 years compared to younger children (69.4% and 52.7% vs. 21% and 5.6%, respectively; p < .0001), the latter succeeding only in TB measurement in 77.4% of cases. In 130 files with both ER and BH measurements (nNO-ER and nNO-BH), nNO-BH was 102 [96.2; 108.3]% that of nNO-ER. In 175 files including nNO-ER and nNO-TB measurements, nNO-TB was 64.4 [IQR: 53.7; 80.4]% that of nNO-ER with an excellent correlation between nNO values (r = .94 [95% CI 0.91; 0.95]; p < .0001) and discordance in the interpretation of nNO results in 16 (10.2%) cases. Final PCD diagnosis was similar in patients included before or after 5 years of age (confirmed 16 (15.2%) and 48 (17.8%); excluded 81 (77.1%) and 192 (71.4%), respectively; p = .32). In conclusion, reliable nNO-BH and nNO-ER results are interchangeable. Children tested with ER or with TB method have similar final PCD diagnosis. Alternative methods to measure nNO might be studied further for use in clinical practice.
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Affiliation(s)
- Nicole Beydon
- APHP, Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires (EFR), Hôpital Armand-Trousseau, Paris, France.,INSERM U934, Centre de Recherche Saint Antoine, Paris, France
| | - Aline Tamalet
- AP-HP, Centre de Référence des Maladies Respiratoires Rares, Service de pneumologie pédiatrique, Hôpital Armand-Trousseau, Paris, France
| | - Estelle Escudier
- AP-HP Département de Génétique médicale, Sorbonne Université, Inserm UMR_S933 Maladies génétiques d'expression pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Marie Legendre
- AP-HP Département de Génétique médicale, Sorbonne Université, Inserm UMR_S933 Maladies génétiques d'expression pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Guillaume Thouvenin
- INSERM U934, Centre de Recherche Saint Antoine, Paris, France.,AP-HP, Centre de Référence des Maladies Respiratoires Rares, Service de pneumologie pédiatrique, Hôpital Armand-Trousseau, Paris, France
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7
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Nasal Nitric Oxide Measurement in Primary Ciliary Dyskinesia. A Technical Paper on Standardized Testing Protocols. Ann Am Thorac Soc 2021; 17:e1-e12. [PMID: 31770003 DOI: 10.1513/annalsats.201904-347ot] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Nasal nitric oxide concentrations are extremely low in primary ciliary dyskinesia (PCD), and measurement of this nasal gas is recommended as a PCD diagnostic test in cooperative patients aged 5 years and older. However, nasal nitric oxide measurements must be performed with chemiluminescence analyzers using a standardized protocol to ensure proper results, because nasal nitric oxide values can be influenced by various internal and external factors. Repeat nasal nitric oxide testing on separate visits is required to ensure that low diagnostic values are persistent and consistent with PCD. This technical paper presents the standard operating procedures for nasal nitric oxide measurement used by the PCD Foundation Clinical and Research Centers Network at various specialty centers across North America. Adherence to this document ensures reliable nasal nitric oxide testing and high diagnostic accuracy when employed in a population with appropriate clinical phenotypes for PCD.
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8
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Gileles-Hillel A, Mor-Shaked H, Shoseyov D, Reiter J, Tsabari R, Hevroni A, Cohen-Cymberknoh M, Amirav I, Brammli-Greenberg S, Horani A, Kerem E, Breuer O. Whole-exome sequencing accuracy in the diagnosis of primary ciliary dyskinesia. ERJ Open Res 2020; 6:00213-2020. [PMID: 33447612 PMCID: PMC7792814 DOI: 10.1183/23120541.00213-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023] Open
Abstract
The diagnosis of primary ciliary dyskinesia (PCD) relies on clinical features and sophisticated studies. The detection of bi-allelic disease-causing variants confirms the diagnosis. However, a standardised genetic panel is not widely available and new disease-causing genes are continuously identified. To assess the accuracy of untargeted whole-exome sequencing (WES) as a diagnostic tool for PCD, patients with symptoms highly suggestive of PCD were consecutively included. Patients underwent measurement of nasal nitric oxide (nNO) levels, ciliary transmission electron microscopy analysis (TEM) and WES. A confirmed PCD diagnosis in symptomatic patients was defined as a recognised ciliary ultrastructural defect on TEM and/or two pathogenic variants in a known PCD-causing gene. Forty-eight patients (46% male) were enrolled, with a median age of 10.0 years (range 1.0–37 years). In 36 patients (75%) a diagnosis of PCD was confirmed, of which 14 (39%) patients had normal TEM. A standalone untargeted WES had a diagnostic yield of 94%, identifying bi-allelic variants in 11 known PCD-causing genes in 34 subjects. A nNO<77 nL·min was nonspecific when including patients younger than 5 years (area under the receiver operating characteristic curve (AUC) 0.75, 95% CI 0.60–0.90). Consecutive WES considerably improved the diagnostic accuracy of nNO in young children (AUC 0.97, 95% CI 0.93–1). Finally, WES established an alternative diagnosis in four patients. In patients with clinically suspected PCD and low nNO levels, WES is a simple, beneficial and accurate next step to confirm the diagnosis of PCD or suggest an alternative diagnosis, especially in preschool-aged children in whom nNO is less specific. Untargeted whole-exome sequencing in subjects with clinical symptoms highly suggestive of PCD has an excellent diagnostic accuracy and, as prices drop, may be the genetic test of choice for confirming PCD or establishing an alternative diagnosishttps://bit.ly/3j2jMbu
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Affiliation(s)
- Alex Gileles-Hillel
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hagar Mor-Shaked
- Monique and Jacques Roboh Department of Genetic Research, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Joel Reiter
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Israel Amirav
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Pediatric Pulmonology Unit, Tel Aviv, Israel
| | - Shuli Brammli-Greenberg
- The Department of Management, Policy and Health Economics, School of Public Health, The Hebrew University of Jerusalem, Israel
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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9
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Gardner LE, Horton KL, Shoemark A, Lucas JS, Nielsen KG, Kobbernagel H, Rubbo B, Hirst RA, Kouis P, Ullmann N, Reula A, Rumman N, Mitchison HM, Pinto A, Richardson C, Schmidt A, Thompson J, Gaupmann R, Dabrowski M, Mill P, Carr SB, Norris DP, Kuehni CE, Goutaki M, Hogg C. Proceedings of the 4 th BEAT-PCD Conference and 5 th PCD Training School. BMC Proc 2020; 14:7. [PMID: 32577127 PMCID: PMC7304082 DOI: 10.1186/s12919-020-00191-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is an inherited ciliopathy leading to chronic suppurative lung disease, chronic rhinosinusitis, middle ear disease, sub-fertility and situs abnormalities. As PCD is rare, it is important that scientists and clinicians foster international collaborations to share expertise in order to provide the best possible diagnostic and management strategies. 'Better Experimental Approaches to Treat Primary Ciliary Dyskinesia' (BEAT-PCD) is a multidisciplinary network funded by EU COST Action (BM1407) to coordinate innovative basic science and clinical research from across the world to drive advances in the field. The fourth and final BEAT-PCD Conference and fifth PCD Training School were held jointly in March 2019 in Poznan, Poland. The varied program of plenaries, workshops, break-out sessions, oral and poster presentations were aimed to enhance the knowledge and skills of delegates, whilst also providing a collaborative platform to exchange ideas. In this final BEAT-PCD conference we were able to build upon programmes developed throughout the lifetime of the COST Action. These proceedings report on the conference, highlighting some of the successes of the BEAT-PCD programme.
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Affiliation(s)
- Laura E Gardner
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | - Katie L Horton
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Amelia Shoemark
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Kim G Nielsen
- Danish PCD & Child Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Helene Kobbernagel
- Danish PCD & Child Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, ERN Accredited, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Robert A Hirst
- Department of Respiratory Sciences, Centre for PCD Diagnosis and Research, University of Leicester, RKCSB, Leicester, LE2 7LX UK
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Nicola Ullmann
- Paediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ana Reula
- Pathology Department, University of Valencia, Valencia, Spain.,Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
| | - Nisreen Rumman
- Department of Pediatrics, Makassed Hospital, East Jerusalem, Palestine
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Programme, University College London, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andreia Pinto
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | - Charlotte Richardson
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | - Anne Schmidt
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - René Gaupmann
- Department of Paediatrics, Division of Paediatric Allergy, Pulmology, and Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Maciej Dabrowski
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Pleasantine Mill
- MRC Human Genetics Unit, MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU UK
| | - Siobhan B Carr
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
| | | | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, University Children's Hospital, University of Bern, Bern, Switzerland
| | - Claire Hogg
- Primary Ciliary Dyskinesia Centre, Royal Brompton Hospital, Sydney Street, London, UK
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10
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Marthin JK, Philipsen MC, Rosthoj S, Nielsen KG. Infant nasal nitric oxide over time: natural evolution and impact of respiratory tract infection. Eur Respir J 2018; 51:13993003.02503-2017. [PMID: 29748307 DOI: 10.1183/13993003.02503-2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/26/2018] [Indexed: 11/05/2022]
Abstract
Nasal nitric oxide (NO) discriminates between patients with primary ciliary dyskinesia (PCD) and healthy individuals. We report feasibility of measurement and natural evolution of nasal NO and upon the impact of respiratory tract infection (RTI) on nasal NO in healthy infants (HI), followed from birth until age 2 years, with comparison to nasal NO in infant PCD.Tidal-breathing nasal NO measurements were performed at scheduled visits at 2 weeks old and at 4, 8, 12, 18 and 24 months old, with extra visits during RTIs. Historical nasal NO measurements for infant PCD were included for comparison.Altogether, 224 nasal NO measurements were performed in 44 enrolled infants. Median newborn nasal NO was 46 ppb (interquartile range (IQR) 29-69 ppb), increasing at a rate of 5.4% per month up to 283 ppb (IQR 203-389 ppb) at the age of 2 years. RTIs in 27 out of 44 infants temporarily suppressed nasal NO by 79%. Values for nasal NO in seven infants with PCD ranged from 6-80 ppb. The success rate to accept nasal NO sampling was 223 out of 224 measurements (99.6%).Tidal-breathing nasal NO measurement was indeed feasible in infancy and nasal NO in HI increased significantly up to 2 years of age, in opposition to nasal NO in PCD cases, which stayed low past 2 years of age. RTI episodes caused marked, temporary reductions in nasal NO in HI indistinguishable from that in infant PCD, suggesting that nasal NO should be measured in RTI-free intervals.
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Affiliation(s)
- June K Marthin
- Danish PCD & chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Dept of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria C Philipsen
- Danish PCD & chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Dept of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Rosthoj
- Faculty of Health Sciences, Institute of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Kim G Nielsen
- Danish PCD & chILD Centre, CF Centre Copenhagen, Pediatric Pulmonary Service, Dept of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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11
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Lucas JS, Walker WT. NO way! Nasal nitric oxide measurement in infants. Eur Respir J 2018; 51:51/6/1800958. [DOI: 10.1183/13993003.00958-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 12/29/2022]
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12
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Zahid M, Bais A, Tian X, Devine W, Lee DM, Yau C, Sonnenberg D, Beerman L, Khalifa O, Lo CW. Airway ciliary dysfunction and respiratory symptoms in patients with transposition of the great arteries. PLoS One 2018; 13:e0191605. [PMID: 29444099 PMCID: PMC5812576 DOI: 10.1371/journal.pone.0191605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Our prior work on congenital heart disease (CHD) with heterotaxy, a birth defect involving randomized left-right patterning, has shown an association of a high prevalence of airway ciliary dysfunction (CD; 18/43 or 42%) with increased respiratory symptoms. Furthermore, heterotaxy patients with ciliary dysfunction were shown to have more postsurgical pulmonary morbidities. These findings are likely a reflection of the common role of motile cilia in both airway clearance and left-right patterning. As CHD comprising transposition of the great arteries (TGA) is commonly thought to involve disturbance of left-right patterning, especially L-TGA with left-right ventricular inversion, we hypothesize CHD patients with transposition of great arteries (TGA) may have high prevalence of airway CD with increased respiratory symptoms. METHODS AND RESULTS We recruited 75 CHD patients with isolated TGA, 28% L and 72% D-TGA. Patients were assessed using two tests typically used for evaluating airway ciliary dysfunction in patients with primary ciliary dyskinesia (PCD), a recessive sinopulmonary disease caused by respiratory ciliary dysfunction. This entailed the measurement of nasal nitric oxide (nNO), which is typically low with PCD. We also obtained nasal scrapes and conducted videomicroscopy to assess respiratory ciliary motion (CM). We observed low nNO in 29% of the patients, and abnormal CM in 57%, with 22% showing both low nNO and abnormal CM. No difference was observed for the prevalence of either low nNO or abnormal ciliary motion between patients with D vs. L-TGA. Respiratory symptoms were increased with abnormal CM, but not low nNO. Sequencing analysis showed no compound heterozygous or homozygous mutations in 39 genes known to cause PCD, nor in CFTR, gene causing cystic fibrosis. As both are recessive disorders, these results indicate TGA patients with ciliary dysfunction do not have PCD or cystic fibrosis (which can cause low nNO or abnormal ciliary motion). CONCLUSIONS TGA patients have high prevalence of abnormal CM and low nNO, but ciliary dysfunction was not correlated with TGA type. Differing from PCD, respiratory symptoms were increased with abnormal CM, but not low nNO. Together with the negative findings from exome sequencing analysis, this would suggest TGA patients with ciliary dysfunction do not have PCD but nevertheless may suffer from milder airway clearance deficiency. Further studies are needed to investigate whether such ciliary dysfunction is associated with increased postsurgical complications as previously observed in CHD patients with heterotaxy.
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Affiliation(s)
- Maliha Zahid
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Abha Bais
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Xin Tian
- Office of Biostatistics Research, National Heart Lung Blood Institute, Bethesda, Maryland, United States of America
| | - William Devine
- Dept. of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Dong Ming Lee
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Cyrus Yau
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Daniel Sonnenberg
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Lee Beerman
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Omar Khalifa
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Cecilia W. Lo
- Dept. of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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13
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Adams PS, Zahid M, Khalifa O, Feingold B, Lo CW. Low Nasal NO in Congenital Heart Disease With Systemic Right Ventricle and Postcardiac Transplantation. J Am Heart Assoc 2017; 6:JAHA.117.007447. [PMID: 29212650 PMCID: PMC5779050 DOI: 10.1161/jaha.117.007447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background NO bioavailability has not been systematically examined in congenital heart disease (CHD). To assess NO in patients with CHD, we measured nasal NO (nNO) generated by the nasal epithelia, given blood NO is difficult to measure (half‐life, <2 ms). Given NO's role in hemodynamic regulation and the association of NO bioavailability with heart failure risk, we hypothesized NO levels may differ with varying severity of CHD physiologic characteristics. Methods and Results Six‐hundred eighteen subjects, 483 with CHD and 135 controls, had nNO measured noninvasively via the nares using American Thoracic Society/European Respiratory Society guidelines. Subjects were dichotomized as having low or normal nNO based on age‐specific cutoff values. Prevalence of low nNO was examined by various CHD physiologic feature types. Low nNO was more prevalent with CHD than controls (odds ratio, 2.28; P=0.001). A logistic regression model showed overall significance (P=0.035) for single ventricle, systemic right ventricle, ventricular dysfunction, oxygen desaturation, and heterotaxy predicting low nNO, with systemic right ventricle independently having twice the odds of low nNO (odds ratio, 2.04; P=0.014). Patients with low nNO had a higher risk of experiencing heart transplant or death (hazard ratio, 2.75; P=0.048), and heart transplant recipients (N=16) exhibited 5 times the odds of low nNO (69% versus 30%; odds ratio, 5.1; P=0.001). Conclusions Patients with CHD have increased prevalence of low nNO, with highest odds seen with systemic right ventricle and heart transplant. Further studies are needed to investigate heart failure risks in patients with CHD with left versus right systemic ventricle physiologic characteristics and utility of low nNO for predicting heart failure risk.
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Affiliation(s)
- Phillip S Adams
- Division of Pediatric Anesthesiology, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maliha Zahid
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Omar Khalifa
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brian Feingold
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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14
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Airway ciliary dysfunction: Association with adverse postoperative outcomes in nonheterotaxy congenital heart disease patients. J Thorac Cardiovasc Surg 2017; 155:755-763.e7. [PMID: 29056267 DOI: 10.1016/j.jtcvs.2017.09.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/30/2017] [Accepted: 09/10/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Heterotaxy (HTX) congenital heart disease (CHD) patients with ciliary dysfunction (CD) have been shown to have increased postoperative respiratory morbidity. We hypothesized that non-HTX CHD infants with CD also will have increased postoperative morbidity, particularly respiratory complications. METHODS Sixty-three infants with non-HTX CHD undergoing cardiac surgery were enrolled. Tests commonly used to assess for CD, nasal nitric oxide (nNO) measurements and nasal epithelial ciliary motion (CM) assessment, were obtained. Baseline characteristics and postoperative outcomes were collected and analyzed. RESULTS Non-HTX CHD infants exhibited a high prevalence of abnormal CM (32%) and low nNO (39%). This finding was not correlated with demographics or surgical complexity. Infants with abnormal CM had increased odds of requiring noninvasive positive pressure ventilation (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.5-29.4; P = .016) and respiratory medication use (OR, 4.4; 95% CI, 1.5-13.3; P = .01). In contrast, infants with low nNO showed evidence of abnormal pre- and postoperative systolic function (40% vs 4%; P = .004, and 34% vs 13%; P = .056, respectively) and had greater odds of acquiring infections (OR, 4.9; 95% CI, 1.4-17; P = .014). CONCLUSIONS Non-HTX CHD infants with abnormal CM showed increased postoperative morbidity associated with poor respiratory outcomes. In contrast, low nNO correlated with reduced hemodynamic function. These findings suggest screening for abnormal CM may allow perioperative interventions to reduce pulmonary morbidities. Whether low nNO may prognosticate poor hemodynamic function warrants further investigation.
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Kuehni CE, Lucas JS. Diagnosis of primary ciliary dyskinesia: summary of the ERS Task Force report. Breathe (Sheff) 2017; 13:166-178. [PMID: 28894478 PMCID: PMC5584715 DOI: 10.1183/20734735.008517] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Key points Primary ciliary dyskinesia (PCD) is a genetically and clinically heterogeneous disease characterised by abnormal motile ciliary function. There is no “gold standard” diagnostic test for PCD. The European Respiratory Society (ERS) Task Force Guidelines for diagnosing PCD recommend that patients should be referred for diagnostic testing if they have several of the following features: persistent wet cough; situs anomalies; congenital cardiac defects; persistent rhinitis; chronic middle ear disease with or without hearing loss; or a history, in term infants, of neonatal upper and lower respiratory symptoms or neonatal intensive care admission. The ERS Task Force recommends that patients should be investigated in a specialist PCD centre with access to a range of complementary tests: nasal nitric oxide, high-speed video microscopy analysis and transmission electron microscopy. Additional tests including immunofluorescence labelling of ciliary proteins and genetic testing may also help determine the diagnosis.
Educational aims This article is intended for primary and secondary care physicians interested in primary ciliary dyskinesia (PCD), i.e. those who identify patients for testing, and those involved in diagnosing and managing PCD patients. It aims:
to inform readers about the new European Respiratory Society Task Force Guidelines for diagnosing patients with PCD to enable primary and secondary care physicians to: identify patients who need diagnostic testing; understand the diagnostic tests that their patients will undergo, the results of the tests and their limitations; and ensure that appropriate care is subsequently delivered.
What primary and secondary care physicians should know about the diagnosis of primary ciliary dyskinesiahttp://ow.ly/obix30drts1
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Affiliation(s)
- Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Menou A, Babeanu D, Paruit HN, Ordureau A, Guillard S, Chambellan A. Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence. J Breath Res 2017; 11:036008. [PMID: 28579561 DOI: 10.1088/1752-7163/aa76ef] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. METHODS Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. RESULTS The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. CONCLUSION The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.
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Affiliation(s)
- A Menou
- Faculte des Sciences, Université de Nantes, Nantes, France
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17
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Panigrahy A, Lo CW. Reply. J Pediatr 2017; 185:253-254. [PMID: 28283257 DOI: 10.1016/j.jpeds.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ashok Panigrahy
- Department of Pediatric Radiology Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
| | - Cecilia W Lo
- Department of Developmental Biology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
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Lucas JS, Barbato A, Collins SA, Goutaki M, Behan L, Caudri D, Dell S, Eber E, Escudier E, Hirst RA, Hogg C, Jorissen M, Latzin P, Legendre M, Leigh MW, Midulla F, Nielsen KG, Omran H, Papon JF, Pohunek P, Redfern B, Rigau D, Rindlisbacher B, Santamaria F, Shoemark A, Snijders D, Tonia T, Titieni A, Walker WT, Werner C, Bush A, Kuehni CE. European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia. Eur Respir J 2017; 49:13993003.01090-2016. [PMID: 27836958 DOI: 10.1183/13993003.01090-2016] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/25/2016] [Indexed: 01/30/2023]
Abstract
The diagnosis of primary ciliary dyskinesia is often confirmed with standard, albeit complex and expensive, tests. In many cases, however, the diagnosis remains difficult despite the array of sophisticated diagnostic tests. There is no "gold standard" reference test. Hence, a Task Force supported by the European Respiratory Society has developed this guideline to provide evidence-based recommendations on diagnostic testing, especially in light of new developments in such tests, and the need for robust diagnoses of patients who might enter randomised controlled trials of treatments. The guideline is based on pre-defined questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. It focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence. It then used a modified Delphi survey to develop an algorithm for the use of diagnostic tests to definitively confirm and exclude the diagnosis of primary ciliary dyskinesia; and to provide advice when the diagnosis was not conclusive. Finally, this guideline proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia.
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Affiliation(s)
- Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Angelo Barbato
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padova, Italy
| | - Samuel A Collins
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Dept of Paediatrics, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Daan Caudri
- Telethon Kids Institute, The University of Western Australia, Subiaco, Australia.,Dept of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Sharon Dell
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Dept of Pediatrics and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Estelle Escudier
- Service de Génétique et Embryologie Médicales, Centre de Référence des Maladies Respiratoires Rares, Hôpital Armand Trousseau, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm UMR_S933, Sorbonne Universités (UPMC Univ Paris 06), Paris, France
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Claire Hogg
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Mark Jorissen
- ENT Dept, University Hospitals Leuven, Leuven, Belgium
| | - Philipp Latzin
- Dept of Paediatrics, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Marie Legendre
- Service de Génétique et Embryologie Médicales, Centre de Référence des Maladies Respiratoires Rares, Hôpital Armand Trousseau, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm UMR_S933, Sorbonne Universités (UPMC Univ Paris 06), Paris, France
| | - Margaret W Leigh
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fabio Midulla
- Paediatric Dept, Sapienza University of Rome, Rome, Italy
| | - Kim G Nielsen
- Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Heymut Omran
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Jean-Francois Papon
- AP-HP, Hôpital Kremlin-Bicetre, service d'ORL et de chirurgie cervico-faciale, Le Kremlin-Bicetre, France.,Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Petr Pohunek
- Paediatric Dept, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | | | - Francesca Santamaria
- Pediatric Pulmonology, Dept of Translational Medical Sciences, Federico II University, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Amelia Shoemark
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Deborah Snijders
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padova, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Titieni
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Claudius Werner
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Andrew Bush
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Dehlink E, Hogg C, Carr SB, Bush A. Clinical phenotype and current diagnostic criteria for primary ciliary dyskinesia. Expert Rev Respir Med 2016; 10:1163-1175. [DOI: 10.1080/17476348.2016.1242414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW Research on the biology of cilia, complex hair-like cellular organelles, has greatly informed our understanding of its crucial role in respiratory health and the pathogenesis of primary ciliary dyskinesia (PCD), including the genetics behind this condition. This review will summarize the current state of the art in the field highlighting its clinical implications. RECENT FINDINGS The genetics of PCD have exploded over the past few years as knowledge acquired from model systems has permitted the identification of genes that are key components of the ciliary apparatus and its function. In addition, clinical criteria and diagnostic tools have emerged that permit more clear identification of affected individuals. SUMMARY The rate of progress in the field continues to accelerate through international collaborative efforts and standardization of methods. Although the genetics behind PCD are complex, given the large number of genes associated with disease, as well as the large number of possible mutations even at the individual gene level, this knowledge is rapidly translating in improved diagnostics and hopefully in the near future in the identification of potential therapeutics.
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Affiliation(s)
- Carlos E. Milla
- The Stanford Cystic Fibrosis Center, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, 770 Welch Rd., Ste. 350, Palo Alto, CA 94304, P. +1-650-736-9824, F. +1-650-723-5201,
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