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Chaskes MB, Lopez EM, Kong KA, Ebert CS, Senior BA, Thorp BD, Kimple AJ. Primary ciliary dyskinesia: An update on contemporary diagnosis. Int Forum Allergy Rhinol 2024; 14:866-869. [PMID: 37565263 DOI: 10.1002/alr.23254] [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: 04/28/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
KEY POINTS Primary ciliary dyskinesia (PCD) is a complex diagnosis without a universal diagnostic test Clinicians must have some skepticism of historic diagnoses of PCD Clinicians should consider a diagnosis of PCD in patients with recalcitrant disease.
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Affiliation(s)
- Mark B Chaskes
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Mamuyac Lopez
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - K Albert Kong
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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2
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Seidl E, Gatt D, Wee WB, Wilson D, Ratjen F, Grasemann H. Bronchodilator responsiveness in children with primary ciliary dyskinesia. ERJ Open Res 2024; 10:00611-2023. [PMID: 38226068 PMCID: PMC10789254 DOI: 10.1183/23120541.00611-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/05/2023] [Indexed: 01/17/2024] Open
Abstract
Background Reversible airway obstruction is common in children with primary ciliary dyskinesia. However, the diagnostic value of adding bronchodilator (BD) response testing to routine spirometry is unclear. Methods This is a retrospective analysis of pulmonary function test results obtained from children with primary ciliary dyskinesia seen as outpatients at the Hospital for Sick Children, Toronto. Spirometry results were collected for every appointment with BD response testing ("Visit", with pre-BD and post-BD measurements) as well as for the previous ("Baseline") and following ("Follow-up") encounters. Results A positive BD response was seen in 86 out of 474 (18.1%) of the pulmonary function tests from 82 children with primary ciliary dyskinesia. BD responsiveness was associated with a significant absolute change (±sd) in % predicted forced expiratory volume in 1 s (FEV1) from Baseline to Visit pre-BD (-6.5±10.3%, p<0.001), but not from Baseline to Follow-up (0.4±10.8, p=0.757). Antimicrobial therapy was initiated more commonly following a Visit with a positive BD response (OR 3.8, 95% CI 2.2-6.6) compared to no BD response. Children with a positive BD response had a greater annual decline in FEV1 % predicted compared to those with no BD response (-0.9% per year versus -0.5% per year, p<0.001). The annual decline in FEV1 % predicted was greater in children with multiple compared to one measured positive BD responses (-1.3% per year versus -0.6% per year, p<0.001) and in those not treated with antibiotic therapy following a positive BD response compared to those treated with antibiotics (-1.1% versus -0.6%, p<0.001). Conclusion A positive BD response in children with primary ciliary dyskinesia may help identify those at risk for accelerated lung disease progression.
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Affiliation(s)
- Elias Seidl
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Dvir Gatt
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Wallace B. Wee
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Wilson
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Hartmut Grasemann
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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3
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Alhalabi O, Abdulwahab A, Thomas M. The First Case of a Homozygous CCNO NM 021147.4 Mutation Associated With Primary Ciliary Dyskinesia in Two Indian Siblings. Cureus 2024; 16:e52237. [PMID: 38222993 PMCID: PMC10787941 DOI: 10.7759/cureus.52237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is a heterogeneous autosomal recessive disease marked by organ lateralization in 50% of patients, chronic sinopulmonary disease, infertility in men, and neonatal respiratory distress. Respiratory control cells contain CCNO in their apical cytoplasm, which is necessary for the development of multiciliate cells, basal body amplification, and migration. Reduced generation of multiple motile cilia, a rare form of PCD, has been linked to CCNO gene abnormalities. Individuals with CCNO mutations have been reported to suffer from severe lower respiratory infections that cause progressive impairment of lung function. For the first time, we describe the CCNO NM 021147.4 (c.258 262dup.p, Gln88argfs*8 Homozygous) gene mutation in an Indian consanguineous family that resulted in severe PCD.
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Affiliation(s)
- Ola Alhalabi
- Pediatric Pulmonology, Sidra Medicine, Doha, QAT
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Shi Y, Lei Q, Han Q. Dual-allele heterozygous mutation of DNAH5 gene in a boy with primary ciliary dyskinesia: A case report. Medicine (Baltimore) 2023; 102:e36271. [PMID: 38206729 PMCID: PMC10754609 DOI: 10.1097/md.0000000000036271] [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: 04/26/2023] [Accepted: 11/02/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE To analyze clinical and imaging features, ciliary structure and family gene mutation loci of a primary ciliary dyskinesia (PCD) boy with a dual-allele heterozygous mutation of DNAH5. PATIENT CONCERNS Clinical data of the proband and relatives. Electronic bronchoscopy, transmission electron microscope (TEM) of the cilia and next-generation sequencing (NGS) were performed. PCD-related DNAH5 exon mutation sites were searched. DIAGNOSES A 10-year and 10-month-old boy was hospitalized due to "recurrent cough, expectoration, sputum and shortness of breathing after activity for over 7 years, and aggravated for 1 week." Moderate and fine wet rales were detected in bilateral lungs. Clubbing fingers and toes were observed. In local hospitals, he was diagnosed with Mycoplasma pneumoniae infection and Streptococcus pneumoniae was cultured. INTERVENTIONS Pulmonary function testing showed mixed ventilation dysfunction and positive for bronchial dilation test. Imaging examination and fiberoptic bronchoscopy revealed transposition of all viscera, bilateral pneumonia, and bronchiectasis. TEM detected no loss of the outer dynein arms. NGS identified 2 mutations (c.4360C>T, c.9346C>T) in the DNAH5 gene inherited from healthy parents. OUTCOMES According to literature review until 2022, among 144 exon gene mutations causing amino acid changes, C>T mutation is the most common in 44 cases, followed by deletion mutations in 30 cases. Among the amino acid changes induced by gene mutation, terminated mutations were identified in 89 cases. LESSONS For suspected PCD patients, TEM and NGS should be performed. Prompt diagnosis and treatment may delay the incidence of bronchiectasis and improve clinical prognosis.
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Affiliation(s)
- Yu Shi
- Department of Respiratory, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Qihong Lei
- Department of Respiratory, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Han
- Department of Respiratory, Children’s Hospital of Nanjing Medical University, Nanjing, China
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5
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Seidl E, Licht JC, Wee WB, Post M, Ratjen F, Grasemann H. Exhaled Volatile Organic Compound Profiles Differ between Children with Primary Ciliary Dyskinesia and Cystic Fibrosis. Ann Am Thorac Soc 2023; 20:1667-1672. [PMID: 37555716 DOI: 10.1513/annalsats.202302-165rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/08/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Elias Seidl
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
- Department of Pediatrics Ludwig Maximilian University of Munich Munich, Germany
| | - Johann-Christoph Licht
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
- Translational Medicine Research Institute Toronto, Ontario, Canada
| | - Wallace B Wee
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
| | - Martin Post
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
- Translational Medicine Research Institute Toronto, Ontario, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine and Department of Pediatrics University of Toronto Toronto, Ontario, Canada
- Translational Medicine Research Institute Toronto, Ontario, Canada
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Alexandru M, Veil R, Rubbo B, Goutaki M, Kim S, Lam YT, Nevoux J, Lucas JS, Papon JF. Ear and upper airway clinical outcome measures for use in primary ciliary dyskinesia research: a scoping review. Eur Respir Rev 2023; 32:220200. [PMID: 37437912 DOI: 10.1183/16000617.0200-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by pulmonary, otological and sino-nasal manifestations. Well-defined clinical outcome measures are needed in such rare diseases research to improve follow-up and treatments. Pulmonary outcome measures have recently been described. The aim of this study was to identify ear and upper airway outcome measures that could be used for longitudinal follow-up of individuals with PCD. METHODS A scoping review was performed by systematically searching MEDLINE, Embase and Cochrane Database of Systematic Reviews online databases for studies published from January 1996 to March 2022 that included at least 10 adult or paediatric PCD patients and reported ear and upper airway outcomes. RESULTS 33 studies (1794 patients) were included. 10 ear and upper airway outcomes were reported. 17 studies reported audiometry, 16 reported otoscopic findings, and 13 reported rhinoscopic findings and sinus imaging. Health-related quality of life questionnaires were performed in seven studies. There was a high variability in definitions and measurement of outcomes between studies. CONCLUSIONS This scoping review highlights the lack of data regarding ear and upper airway outcomes in PCD. It also reports a high heterogeneity in outcome definitions or measures. We provide well-founded specific suggestions to standardise ear and upper airway outcome definitions and reporting for future PCD research studies.
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Affiliation(s)
- Mihaela Alexandru
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Raphaël Veil
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'Épidémiologie et Santé Publique, Le Kremlin-Bicêtre, France
| | - Bruna Rubbo
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Sookyung Kim
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jérôme Nevoux
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jean-François Papon
- AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Institut Mondor de Recherche Biomédicale INSERM-UPEC UMR 955, CNRS ERL7000, Créteil, France
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Lin HT, Gupta A, Bove KE, Szabo S, Xu F, Krentz A, Shillington AL. Novel Pathogenic DNAH5 Variants in Primary Ciliary Dyskinesia: Association with Visceral Heterotaxia and Neonatal Cholestasis. J Pediatr Genet 2023; 12:246-253. [PMID: 37575649 PMCID: PMC10421694 DOI: 10.1055/s-0041-1733940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/23/2021] [Indexed: 10/20/2022]
Abstract
The dynein axonemal heavy chain 5 gene codes for a subunit of axonemal dynein necessary for ciliary motor function. Though research has elucidated the consequences of some variants in this gene, it is still unclear whether many variants in the DNAH5 locus are benign or pathogenic due to the rarity of primary ciliary dyskinesia (PCD, of which Kartagener's syndrome is a subset). Here, we introduce the case of an infant boy presenting with the classical findings of PCD along with visceral heterotaxia and neonatal cholestasis. Genetic testing indicated that the patient is a compound heterozygote with a pathogenic c.8498G > A (known as pathogenic) on the maternally derived allele and two variants of uncertain significance, c.1206T > A and c.7800T > G, on the paternally derived allele. As PCD is autosomal recessive, we conclude that one, or both, of these paternally derived variants are pathogenic. To our knowledge, this is the first time that the clinical implications of c.1206T > A (p.Asn402Lys) and c.7800T > G (p.Ile2600Met) are documented. Furthermore, we use this case as an example to recommend clinicians to assess for PCD and laterality defects when presented with severe infantile cholestasis. While the association of cholestasis with PCD is relatively uncommon, PCD is a risk factor for increased prevalence of biliary atresia and infections, both of which are known causes of cholestasis in early infancy.
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Affiliation(s)
- Hong T. Lin
- College of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Anita Gupta
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kevin E. Bove
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Sara Szabo
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Fang Xu
- PreventionGenetics, Marshfield, Wisconsin, United States
| | - Anthony Krentz
- PreventionGenetics, Marshfield, Wisconsin, United States
| | - Amelle L. Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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Lee EY, Hughes JW. Rediscovering Primary Cilia in Pancreatic Islets. Diabetes Metab J 2023; 47:454-469. [PMID: 37105527 PMCID: PMC10404530 DOI: 10.4093/dmj.2022.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Primary cilia are microtubule-based sensory and signaling organelles on the surfaces of most eukaryotic cells. Despite their early description by microscopy studies, islet cilia had not been examined in the functional context until recent decades. In pancreatic islets as in other tissues, primary cilia facilitate crucial developmental and signaling pathways in response to extracellular stimuli. Many human developmental and genetic disorders are associated with ciliary dysfunction, some manifesting as obesity and diabetes. Understanding the basis for metabolic diseases in human ciliopathies has been aided by close examination of cilia action in pancreatic islets at cellular and molecular levels. In this article, we review the evidence for ciliary expression on islet cells, known roles of cilia in pancreas development and islet hormone secretion, and summarize metabolic manifestations of human ciliopathy syndromes. We discuss emerging data on primary cilia regulation of islet cell signaling and the structural basis of cilia-mediated cell crosstalk, and offer our interpretation on the role of cilia in glucose homeostasis and human diseases.
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Affiliation(s)
- Eun Young Lee
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jing W. Hughes
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Jung R, Choi J, Bae H, Jung DI, Cho KO, Yu D. Siewert-Kartagener's syndrome in a dog. J Vet Sci 2023; 24:e57. [PMID: 37532300 PMCID: PMC10404705 DOI: 10.4142/jvs.23029] [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: 01/25/2023] [Revised: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 08/04/2023] Open
Abstract
Siewert-Kartagener's syndrome, a type of primary ciliary dyskinesia, is a complex disease comprising situs inversus, rhinosinusitis, and bronchiectasis. Situs inversus totalis is a condition in which all organs in the thoracic and abdominal cavities are reversed. Furthermore, primary ciliary dyskinesia, an autosomal genetic disease, may coexist with situs inversus totalis. Reports on Siewert-Kartagener's syndrome in veterinary medicine are limited. We report a rare case of primary ciliary dyskinesia with Siewert-Kartagener's syndrome in a dog, concurrently infected with canine distemper virus and type-2 adenovirus. This case highlights that situs inversus totalis can cause primary ciliary dyskinesia, and concurrent infections are possible.
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Affiliation(s)
- Rankyung Jung
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Jihye Choi
- College of Veterinary Medicine, Seoul National University, Seoul 08826, Korea
| | - Hyeona Bae
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Dong-In Jung
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - Kyoung-Oh Cho
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea.
| | - DoHyeon Yu
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea.
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Prevalence and founder effect of DRC1 exon 1-4 deletion in Korean patients with primary ciliary dyskinesia. J Hum Genet 2023; 68:369-374. [PMID: 36747106 DOI: 10.1038/s10038-023-01122-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 02/08/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disorder affecting ciliary structure and function. PCD exhibiting dynein regulatory complex subunit 1 (DRC1) exon 1-4 deletion has been reported in several Japanese PCD patients; however, no large scale studies have been performed. Here, we aimed to determine the prevalence and founder effect of this variant in the Korean population. Using an in-house copy number variation tool, we screened for DRC1 exon 1-4 deletion in 20 patients with PCD and exome data of 1435 patients in the Seoul National University Hospital repository. In cases of suspected DRC1 deletion, confirmatory gap-PCR was performed. In a PCD cohort, three of 20 (15%) patients were positive for DRC1 exon 1-4 deletion (NM_145038.5(DRC1): c.1-3952_540 + 1331del27748-bp) while pathogenic variants were found in CCDC39 (N = 1), DNAAF6 (N = 1), DNAH9 (N = 1). In the 1,435-sample exome data, seven patients (0.49%) were confirmed to have DRC1 exon 1-4 deletion. A chimeric sequence including the junction was searched from the 1000 Genomes Project data repository. One Japanese patient (0.96%) was found to have the same DRC1 exon 1-4 deletion, which was absent in other populations. This study demonstrated that the DRC1 exon 1-4 deletion is a founder mutation based on haplotype analysis. In summary, the prevalence of PCD based on DRC1 exon 1-4 deletion is particularly high in Korean and Japanese populations, which is attributed to the founder effect. Genetic testing for DRC1 exon 1-4 deletion should be considered as an initial screening tool for Korean and Japanese patients with PCD.
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Lung Function in Children with Primary Ciliary Dyskinesia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020290. [PMID: 36832419 PMCID: PMC9955480 DOI: 10.3390/children10020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is characterized by impaired mucociliary clearance that results in accumulation of mucus and bacteria in the airways. Lower respiratory tract infections lead to airway remodeling and lung function impairment. The aim of our narrative review is to discuss available data on lung function in PCD children, focusing on risk factors for lung function impairment. METHODS Relevant published studies searching MEDLINE/Pubmed are included in this narrative review, using these terms: "primary ciliary dyskinesia" and "pulmonary function test" or "spirometry" or "lung function". Filters were language (English) and age of study subjects (0-18 years). RESULTS AND CONCLUSIONS The majority of recent published studies showed normal spirometric values in PCD children, even if some authors described a pulmonary impairment. Together with spirometry, Lung Clearance Index has been applied for detecting peripheral airway disease, and it might have a role in early mild lung disease assessment. Studies on lung function trajectories after PCD diagnosis showed a significant heterogeneity, with some patients maintaining reasonably good lung function, whereas others showing a decline. Further studies are needed to analyze lung function prospectively from childhood into adulthood, and to evaluate whether lung function trajectories are affected by PCD clinical phenotype, ultrastructural ciliary defect or genetic background.
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12
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In vitro measurement of ciliary beat frequency in 92 children with recurrent respiratory tract problems. J Laryngol Otol 2022; 136:1183-1188. [DOI: 10.1017/s0022215121003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AbstractBackgroundChronic or recurrent mucoid respiratory tract symptoms may be difficult to diagnose.MethodNinety-two children with chronic respiratory symptoms were divided into 4 groups: 18 children with refractory asthma, 10 with bronchiectasis without dextrocardia, 18 with dextrocardia and 46 with recurrent respiratory tract infections. Except for five neonates, cytology samples were taken under general anaesthesia. Ciliary beat frequency was measured photometrically and analysed by in-house computer software.ResultsNasal polyps were found in one child with normal ciliary beat frequency. Twenty-six children had no beating cilia (male to female ratio, 15:11). The effect of increasing temperature on the ciliary beat frequency of the remaining 66 patients was evaluated (42 patients, more than 30°C, median, 8.3 Hz; 24 patients, 30–37°C, median, 11.8 Hz; p = 0.0003).ConclusionThe measurement of ciliary beat frequency is part of the diagnostic work up of patients with persistent or recurrent respiratory tract infections.
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Ye Y, Huang Q, Chen L, Yuan F, Liu S, Zhang X, Chen R, Fu Y, Yue Y. Pathogenic variants identified using whole-exome sequencing in Chinese patients with primary ciliary dyskinesia. Am J Med Genet A 2022; 188:3024-3031. [PMID: 35869935 DOI: 10.1002/ajmg.a.62912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 01/31/2023]
Abstract
The genetic factors contributing to primary ciliary dyskinesia (PCD), a rare autosomal recessive disorder, remain elusive for ~20%-35% of patients with complex and abnormal clinical phenotypes. Our study aimed to identify causative variants of PCD-associated pathogenic candidate genes using whole-exome sequencing (WES). All patients were diagnosed with PCD based on clinical phenotype or transmission electron microscopy images of cilia. WES and bioinformatic analysis were then conducted on patients with PCD. Identified candidate variants were validated by Sanger sequencing. Pathogenicity of candidate variants was then evaluated using in silico software and the American College of Medical Genetics and Genomics (ACMG) database. In total, 13 rare variants were identified in patients with PCD, among which were three homozygous causative variants (including one splicing variant) in the PCD-associated genes CCDC40 and DNAI1. Moreover, two stop-gain heterozygous variants of DNAAF3 and DNAH1 were classified as pathogenic variants based on the ACMG criteria. This study identified novel potential pathogenic genetic factors associated with PCD. Noteworthy, the patients with PCD carried multiple rare causative gene variants, thereby suggesting that known causative genes along with other functional genes should be considered for such heterogeneous genetic disorders.
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Affiliation(s)
- Yutian Ye
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Qijun Huang
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Lipeng Chen
- Clinical Centre, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Fang Yuan
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Shengguo Liu
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Xiangxia Zhang
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China.,State Key Laboratory of Respiration Diseases, The First Affiliated Hospital Of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yingyun Fu
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Yongjian Yue
- Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China
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Zhang YY, Lou Y, Yan H, Tang H. CCNO mutation as a cause of primary ciliary dyskinesia: A case report. World J Clin Cases 2022; 10:9148-9155. [PMID: 36157652 PMCID: PMC9477031 DOI: 10.12998/wjcc.v10.i25.9148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is an uncommon and genetically diverse condition. According to reports, most patients had more than 50 visits before being diagnosed with PCD, and the age at diagnosis was mostly in preschool, with an average age of about (10.9 ± 14.4) years old. CCNO is a pathogenic gene that regulates the cell cycle, and its mutation is linked to the uncommon human genetic disorder PCD. Although the prevalence of the CCNO mutation is regarded to be exceptionally low, new reports of this mutation have increased in comparison to prior ones. PCD patients with CCNO are rare, and the incidence rate is no more than 2% in whole PCD patients.
CASE SUMMARY Here, we report a case of a young Chinese woman diagnosed with PCD, who was found to carry the CCNO gene by whole exon gene sequencing. In this case, a young non-smoking Chinese female exhibiting recurrent cough and sputum at birth. Chest computed tomography (CT) showed bronchiectasis with infection, and sinus CT showed chronic sinusitis. However, the patient had no visceral transposition and no history of infertility. Under electron microscope, it was found that cilia were short and reduced in number, and no power arm of cilia was observed. Whole exon sequencing analysis of the genome of the patient showed that the patient carried CCNO pathogenic gene, exon c.303C>A nonsense mutation and c.248_252dup frameshift mutation. Her clinical symptoms and CT images were improved after two months of treatment with aerosol inhalation and oral azithromycin.
CONCLUSION The results showed that CCNO is an important cause of PCD. More mutant genes that may contribute to genetically diverse disorders like PCD have been discovered as sequencing technology has advanced. Furthermore, the increase of genetic information makes it easier to diagnose uncommon diseases in clinical practice.
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Affiliation(s)
- Yun-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Yan Lou
- Department of Orthopedic Oncology, Spine Tumor Center, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
| | - Han Yan
- Department of Nephrology, 905th Hospital of PLA Navy, Naval Military Medical University, Shanghai 200050, China
| | - Hao Tang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China
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15
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Alexandru M, de Boissieu P, Benoudiba F, Moustarhfir M, Kim S, Bequignon É, Honoré I, Garcia G, Mitri-Frangieh R, Legendre M, Crestani B, Taillé C, Escudier E, Maitre B, Papon JF, Nevoux J. Otological Manifestations in Adults with Primary Ciliary Dyskinesia: A Controlled Radio-Clinical Study. J Clin Med 2022; 11:jcm11175163. [PMID: 36079093 PMCID: PMC9456589 DOI: 10.3390/jcm11175163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetical disease characterized by an abnormal structure or function of the cilia, causing sinusitis, otitis, and bronchiectasis. Hearing loss affects 60% of PCD patients, but data are lacking concerning hearing and temporal bone imaging in adults. Our aim was to describe clinical and radiological ear disease in adults with genetically confirmed PCD. Data were recorded from January 2018 to December 2019. PCD patients were compared with controls with bronchiectasis without PCD. Clinical examination included otomicroscopy and auditory tests. A temporal bone CT scan (TBCT) was systematically performed. Seventeen patients (34 ears) were included in each group. The eardrums were abnormal in 25 (74%) PCD ears versus 8 (24%) ears in the controls (p < 0.05). Conductive hearing loss was more frequent in the PCD group (24% vs. 12% in controls). TBCT were abnormal in 94% PCD patients vs. 32% in the controls (p < 0.05). The Main CT-scan images in PCD were middle ear inflammation (65%), mastoid condensation (62%), or ossicular anomalies (35%). With its excellent sensitivity, TBCT gives typical arguments for PCD diagnosis, adding otological signs to the usual sinus CT signs (hypoplasia, aplasia). Systematic TBCT could be useful in the initial evaluation of patients with suspicion of PCD.
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Affiliation(s)
- Mihaela Alexandru
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- Correspondence: ; Tel.: +33-145-213-688
| | - Paul de Boissieu
- Epidemiology and Public Health Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Farida Benoudiba
- Diagnostic Neuroradiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Malik Moustarhfir
- Diagnostic Neuroradiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Sookyung Kim
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Émilie Bequignon
- ENT Department, Henri Mondor Hospital, Intercommuncal Hospital of Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est University, 94010 Créteil, France
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
| | - Isabelle Honoré
- Pneumology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75014 Paris, France
| | - Gilles Garcia
- Pneumology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
| | - Rana Mitri-Frangieh
- Department of Anatomy and Cytology Pathology, Intercommuncal Hospital of Créteil, 94010 Créteil, France
| | - Marie Legendre
- Molecular Genetics Functional Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75012 Paris, France
- INSERM, UMR-S933 Genetic Diseases of Pediatric Expression, Sorbonne University, 75005 Paris, France
| | - Bruno Crestani
- Rare Pulmonary Diseases (FHU APOLLO) Pneumology A Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75877 Paris, France
- Laboratory of Excellence Inflamex, 75013 Paris, France
- INSERM U1152, Paris Cité University, 75018 Paris, France
| | - Camille Taillé
- Rare Pulmonary Diseases (FHU APOLLO) Pneumology A Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 75877 Paris, France
- INSERM U1152, Paris Cité University, 75018 Paris, France
- INSERM 12, F-CRIN, Clinical Research Initiative in Severe Asthma: A Lever for Innovation & Science (CRISALIS), 31059 Toulouse, France
| | - Estelle Escudier
- Molecular Genetics Functional Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75012 Paris, France
- INSERM, UMR-S933 Genetic Diseases of Pediatric Expression, Sorbonne University, 75005 Paris, France
| | - Bernard Maitre
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
- Pneumology Department, Henri Mondor Hospital, Intercommuncal Hospital of Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Est University, 94010 Créteil, France
| | - Jean-François Papon
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- Mondor Institute of Biomedical Research INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France
| | - Jérôme Nevoux
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, 94270 Le Kremlin-Bicêtre, France
- INSERM, U1120, Pasteur Institute, 75724 Paris, France
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16
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Wijesekara P, Yadav P, Perkins LA, Stolz DB, Franks JM, Watkins SC, Reinoso Jacome E, Brody SL, Horani A, Xu J, Barati Farimani A, Ren X. Engineering rotating apical-out airway organoid for assessing respiratory cilia motility. iScience 2022; 25:104730. [PMID: 35942088 PMCID: PMC9356180 DOI: 10.1016/j.isci.2022.104730] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Motile cilia project from the airway apical surface and directly interface with inhaled external environment. Owing to cilia's nanoscale dimension and high beating frequency, quantitative assessment of their motility remains a sophisticated task. Here we described a robust approach for reproducible engineering of apical-out airway organoid (AOAO) from a defined number of cells. Propelled by exterior-facing cilia beating, the mature AOAO exhibited stable rotational motion when surrounded by Matrigel. We developed a computational framework leveraging computer vision algorithms to quantify AOAO rotation and correlated it with the direct measurement of cilia motility. We further established the feasibility of using AOAO rotation to recapitulate and measure defective cilia motility caused by chemotherapy-induced toxicity and by CCDC39 mutations in cells from patients with primary ciliary dyskinesia. We expect our rotating AOAO model and the associated computational pipeline to offer a generalizable framework to expedite the modeling of and therapeutic development for genetic and environmental ciliopathies.
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Affiliation(s)
- Piyumi Wijesekara
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
| | - Prakarsh Yadav
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
| | - Lydia A. Perkins
- Department of Biological Sciences, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
| | - Donna B. Stolz
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan M. Franks
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Simon C. Watkins
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Emily Reinoso Jacome
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
| | - Steven L. Brody
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jian Xu
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Amir Barati Farimani
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
| | - Xi Ren
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
- Department of Mechanical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, USA
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17
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McLean C, Brown K, Windmill J, Dennany L. Innovations In Point-Of-Care Electrochemical Detection Of Pyocyanin. J Electroanal Chem (Lausanne) 2022. [DOI: 10.1016/j.jelechem.2022.116649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Demir Eksi D, Yilmaz E, Basaran AE, Erduran G, Nur B, Mihci E, Karadag B, Bingol A, Alper OM. Novel Gene Variants Associated with Primary Ciliary Dyskinesia. Indian J Pediatr 2022; 89:682-691. [PMID: 35239159 DOI: 10.1007/s12098-022-04098-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the demographic, clinical, and genetic profile of Turkish Caucasian PCD cases. METHODS Targeted next-generation sequencing (t-NGS) of 46 nuclear genes was performed in 21 unrelated PCD cases. Sanger sequencing confirmed of potentially disease-related variations, and genotype-phenotype correlations were evaluated. RESULTS Disease-related variations were identified in eight different genes (CCDC39, CCDC40, CCDC151, DNAAF2, DNAAF4, DNAH11, HYDIN, RSPH4A) in 52.4% (11/21) of the cases. The frequency of variations for CCDC151, DNAH11, and DNAAF2 genes which were highly mutated genes in the cohort was 18% in 11 patients. Each of the remaining gene variations was detected once (9%) in different patients. The variants, p.R482fs*12 in CCDC151, p.E216* in DNAAF2, p.I317* in DNAAF4, p.L318P and p.R1865* in DNAH11, and p.N1505D and p.L1167P in HYDIN gene were identified as novel variations. Interestingly, varying phenotypic findings were identified even in patients with the same mutation, which once again confirmed that PCD has a high phenotypic heterogeneity and shows individual differences. CONCLUSION This t-NGS panel is potentially helpful for exact and rapid identification of reported/novel PCD-disease-causing variants to establish the molecular diagnosis of ciliary diseases.
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Affiliation(s)
- Durkadin Demir Eksi
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey.
- Department of Medical Biology, School of Medicine, Alanya Alaaddin Keykubat University, Antalya, 07425, Turkey.
| | - Elanur Yilmaz
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey
- Department of Medical Genetics & Koç University Research Center for Translational Medicine (KUTTAM), School of Medicine, Koç University, Istanbul, Turkey
| | - A Erdem Basaran
- Department of Pediatric Pulmonology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Gizem Erduran
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Banu Nur
- Department of Pediatric Genetics, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ercan Mihci
- Department of Pediatric Genetics, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Aysen Bingol
- Department of Pediatric Pulmonology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozgul M Alper
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey.
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19
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Shah A, Laguna TA. Primary Ciliary Dyskinesia: A Rare and Often Underdiagnosed Disease. Pediatr Ann 2022; 51:e82-e85. [PMID: 35156887 DOI: 10.3928/19382359-20220119-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disease with clinical features of ear, sinus, and pulmonary infections that overlap with common respiratory illnesses of childhood. It is a progressive disorder that has significant influence on quality of life, lung function, and survival. Given the considerable overlap of symptoms between common illnesses and PCD, a high index of suspicion by primary care providers is needed to consider the diagnosis. There is not a single "gold standard" diagnostic test for PCD and multiple diagnostic methods coupled with specialized expertise is often needed to make the diagnosis. Patients with PCD also have comorbidities requiring a multidisciplinary approach for optimal clinical management. It is important for primary care physicians to recognize the PCD clinical phenotype and have a diagnostic framework for these patients. [Pediatr Ann. 2022;51(2):e82-e85.].
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20
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Zhao L, Huang S, Wei W, Zhang B, Shi W, Liang Y, Xu R, Wu Y. Novel compound heterozygous CCDC40 mutations in a familial case of primary ciliary dyskinesia. Front Pediatr 2022; 10:996332. [PMID: 36245716 PMCID: PMC9559825 DOI: 10.3389/fped.2022.996332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by motile ciliary dysfunction and impaired ultrastructure. Despite numerous studies, the genetic basis for about 30% of PCD cases remains to be elucidated. Here, we present the identification and functional analysis of two novel mutations in the gene encoding coiled-coil domain-containing protein 40 (CCDC40), which are found in a familial case of PCD. These novel CCDC40 mutations, NM_017950.4: c.2236-2delA and c.2042_2046delTCACA, NP_060420.2: p.(Ile681fs), were identified by whole-exome sequencing (WES). Sanger sequencing was then performed to confirm the WES results and determine the CCDC40 gene sequences of the proband's parents. The c.2042_2046delTCACA mutation disrupts the reading frame of the protein and is therefore predicted to produce a non-functional protein. Using a minigene assay with the pcDNA3.1(+) plasmid, we further investigated the potential pathogenic effects of the c.2236-2delA mutation and found that this mutation leads to formation of a truncated protein via splicing disruption. Thus, in summary, we identified two mutations of the CCDC40 gene that can be considered pathogenic compound heterozygous mutations in a case of familial PCD, thereby expanding the known mutational spectrum of the CCDC40 gene in this disease.
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Affiliation(s)
- Liqing Zhao
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suqiu Huang
- Department of Pediatrics, Chengdu Second People's Hospital, Chengdu, China
| | - Wei Wei
- Scientific Research Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingyao Zhang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxiang Shi
- Scientific Research Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongzhou Liang
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rang Xu
- Scientific Research Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Alzaid M, Al-Mobaireek K, Almannai M, Mukhtar G, Eltahir S, Zafar A, Zada AP, Alotaibi W. Clinical and molecular characteristics of primary ciliary dyskinesia: A tertiary care centre experience. Int J Pediatr Adolesc Med 2021; 8:258-263. [PMID: 34401452 PMCID: PMC8356118 DOI: 10.1016/j.ijpam.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a ciliopathy with diverse clinical and genetic findings caused by abnormal motile cilia structure and function. In this study, we describe the clinical characteristics of confirmed PCD cases in our population and report the radiological, genetic, and laboratory findings. METHODS This was a retrospective, observational, single-centre study. We enrolled 18 patients who were diagnosed with confirmed PCD between 2015 and 2019. We then analyzed their data, including clinical findings and workup. RESULTS In our cohort, 56% of patients had molecularly confirmed PCD, and RSPH9 was the most common gene identified. Transmission electron microscopy (TEM) showed an ultrastructural defect in 64% of samples, all of which matched the genetic background of the patient. Situs inversus (SI) was observed in 50% of patients, and congenital heart disease was observed in 33%. The median body mass index (BMI) was 15.87 kg/m2, with a median z score of -1.48. The median FEV1 value was 67.6% (z score - 2.43). Radiologically, bronchiectasis was noted in 81% of patients at a variable degree of severity. Lung bases were involved in 91% of patients. We were unable to correlate the genotype-phenotype findings. CONCLUSION We describe the clinical and molecular characteristics of patients with confirmed PCD in a tertiary centre in Saudi Arabia and report 9 new pathogenic or likely pathogenic variants in one of the PCD-associated genes.
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Affiliation(s)
- Mohammed Alzaid
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
- Corresponding author. Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, PO Box 13514, Saudi Arabia.
| | - Khalid Al-Mobaireek
- Pulmonary Division of the Pediatric Department, King Khalid University Hospital, Saudi Arabia
| | - Mohammed Almannai
- Genetic and Metabolic Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Gawahir Mukhtar
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Safa Eltahir
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Adnan Zafar
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | | | - Wadha Alotaibi
- Pathology Department, Kind Fahad Medical City, Saudi Arabia
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22
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Wang L, Zhao X, Liang H, Zhang L, Li C, Li D, Meng X, Meng F, Gao M. Novel compound heterozygous mutations of DNAH5 identified in a pediatric patient with Kartagener syndrome: case report and literature review. BMC Pulm Med 2021; 21:263. [PMID: 34391405 PMCID: PMC8364053 DOI: 10.1186/s12890-021-01586-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kartagener syndrome is a subtype of primary ciliary dyskinesia that may exhibit various symptoms including neonatal respiratory distress and frequent infections of the lung, sinus and middle ear because of the impaired function of motile cilia. In addition to typical symptoms of primary ciliary dyskinesia, patients with Kartagener syndrome also show situs inversus. It is an autosomal recessive disorder which is mostly caused by mutations in DNAH5. Kartagener syndrome is often underdiagnosed due to challenges in the diagnosis process. As next-generation sequencing becomes widely used in clinical laboratories, genetic testing provides an accurate approach to the diagnosis of Kartagener syndrome. CASE PRESENTATION A 7-year-old female patient presented with runny nose of 6 years duration and recurrent cough with phlegm of 2 years duration. Kartagener syndrome was diagnosed through diagnostic tests such as nasal nitric oxide (NO) concentration and transmission electron microscopy, and after performing other exams that corroborated the diagnosis, such as computed tomography, bronchoscopy and hearing test. Whole-exome sequencing was performed for the patient and both parents. The pediatric patient was diagnosed as Kartagener syndrome with the typical symptoms of ciliary dyskinesia including bronchiectasis, sinusitis, conductive hearing loss and situs inversus along with a reduced nasal NO concentration and ciliary abnormalities. The patient carried two novel compound heterozygous mutations in DNAH5, NM_001369:c.12813G > A (p. Trp4271Term) and NM_001369:c.9365delT (p. Leu3122Term). Both mutations lead to premature stop codons and thus are pathogenic. The p. Trp4271Term and p. Leu3122Term mutations were inherited from the father and the mother of the patient individually. A literature review was also conducted to summarize DNAH5 mutations in pediatric patients with Kartagener syndrome across different ethnic groups. CONCLUSIONS Our study provides a good example of the diagnosis of Kartagener syndrome in pediatric patients using a series of diagnostic tests combined with genetic testing. Two novel loss-of-function mutations in DNAH5 were identified and validated in a pediatric patient with Kartagener syndrome.
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Affiliation(s)
- Lina Wang
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | - Xin Zhao
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | - Hang Liang
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | - Li Zhang
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | - Chunyan Li
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | - Deli Li
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China
| | | | - Fanzheng Meng
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China.
| | - Mao Gao
- Pediatric Department of Respiration II, The First Hospital of Jilin University, No.71 Xinmin Street, Changchun, 130000, China.
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23
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The Antimicrobial Activity of Peripheral Blood Neutrophils Is Altered in Patients with Primary Ciliary Dyskinesia. Int J Mol Sci 2021; 22:ijms22126172. [PMID: 34201048 PMCID: PMC8230338 DOI: 10.3390/ijms22126172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 01/13/2023] Open
Abstract
The airways of patients with primary ciliary dyskinesia (PCD) contain persistently elevated neutrophil numbers and CXCL8 levels. Despite their abundance, neutrophils fail to clear the airways from bacterial infections. We investigated whether neutrophil functions are altered in patients with PCD. Neutrophils from patients and healthy controls (HC) were isolated from peripheral blood and exposed to various bacterial stimuli or cytokines. Neutrophils from patients with PCD were less responsive to low levels of fMLF in three different chemotaxis assays (p < 0.05), but expression of the fMLF receptors was unaltered. PCD neutrophils showed normal phagocytic function and expression of adhesion molecules. However, PCD neutrophils produced less reactive oxygen species upon stimulation with bacterial products or cytokines compared to HC neutrophils (p < 0.05). Finally, the capacity to release DNA, as observed during neutrophil extracellular trap formation, seemed to be reduced in patients with PCD compared to HC (p = 0.066). These results suggest that peripheral blood neutrophils from patients with PCD, in contrast to those of patients with cystic fibrosis or COPD, do not show features of over-activation, neither on baseline nor after stimulation. If these findings extend to lung-resident neutrophils, the reduced neutrophil activity could possibly contribute to the recurrent respiratory infections in patients with PCD.
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Anesthetic management of a patient with situs inversus totalis undergoing coronary artery bypass grafting surgery: a case report. JA Clin Rep 2021; 7:28. [PMID: 33782777 PMCID: PMC8007672 DOI: 10.1186/s40981-021-00431-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anesthetic management of coronary artery bypass grafting surgery (CABG) in a dextrocardia patient with situs inversus totalis is rarely encountered and seldom reported in the literature. CASE PRESENTATION A 76-year-old Japanese female patient had been diagnosed with situs inversus totalis and coronary artery disease of 3 vessels, and she subsequently underwent elective CABG. A preoperative examination showed almost normal results. ECG showed right deviation with the normal lead position. In the operating room, ECG leads were applied in reverse. Pulmonary artery catheterization was performed via the left internal jugular vein. A transesophageal echocardiography (TEE) probe was introduced without difficulty. A different angle was needed to acquire the desired views because of her atypical anatomy. CONCLUSION Careful perioperative evaluation, intraoperative management, and inspection of multiplane angle and probe adjustments in TEE are needed for anatomically abnormal patients.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Schultz R, Elenius V, Lukkarinen H, Saarela T. Two novel mutations in the DNAH11 gene in primary ciliary dyskinesia (CILD7) with considerable variety in the clinical and beating cilia phenotype. BMC MEDICAL GENETICS 2020; 21:237. [PMID: 33243178 PMCID: PMC7690114 DOI: 10.1186/s12881-020-01171-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
Background Diagnosis of primary ciliary dyskinesia (PCD) still remains a challenge, especially with mutations in the Dynein Arm Heavy Chain 11 (DNAH11) gene. Classical diagnostic measures like Transmission Electron Microscopy (TEM) are not applicable for mutations in the DNAH11 gene since ultrastructural defects of the ciliary apparatus are absent. Novel mutations encoding for PCD appear all the time with considerable variation in the clinical picture, making it necessary to update data bases and guidelines for PCD diagnostics. Methods In this study we examined two unrelated, Finnish families with symptoms of PCD applying the clinical scoring system: Primary ciliary dyskinesia Rule (PICADAR), high speed video microscopy analysis (HSVMA) for ciliary movement, a commercially available gene panel analysis and nasal Nitric Oxide (nNO) measurements if applicable. Results Two, likely pathogenic variants in the DNAH11 gene (c.2341G > A, p. (Glu781Lys) ja c.7645 + 5G > A) were detected. In the first family, compound heterozygous mutations led to disease manifestation in two of 4 children, which showed a similar phenotype of cilia beating pattern but marked differences in disease severity. In the second family, all three children were homozygotes for the c.2341G > A p.(Glu781Lys) mutation and showed a similar degree of disease severity. However, the phenotype of cilia beating pattern was different ranging from stiff, static cilia to a hyperkinetic movement in one of these children. Conclusions In this study we describe two Finnish families with PCD, revealing two novel mutations in the DNAH11 gene which show considerable variety in the clinical and beating cilia phenotype. The results of this study show the clinician that PCD can be much milder than generally expected and diagnosis demands a combination of measures which are only successful in experienced hands. Chronic and repeatedly treated wet cough should raise suspicion of PCD, referring the patient for further diagnostics to a specialised PCD centre. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01171-2.
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Affiliation(s)
- Rüdiger Schultz
- Tampere University Hospital, Allergy Centre, PB 2000, 33521, Tampere, Finland.
| | - Varpu Elenius
- Department of Pediatrics, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520, Turku, Finland
| | - Heikki Lukkarinen
- Department of Pediatrics, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520, Turku, Finland
| | - Tanja Saarela
- Department of Clinical Genetics, Kuopio University Hospital, PB 1, 70029, Kuopio, Finland
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Rocca MS, Piatti G, Michelucci A, Guazzo R, Bertini V, Vinanzi C, Caligo MA, Valetto A, Foresta C. A novel genetic variant in DNAI2 detected by custom gene panel in a newborn with Primary Ciliary Dyskinesia: case report. BMC MEDICAL GENETICS 2020; 21:220. [PMID: 33167880 PMCID: PMC7654168 DOI: 10.1186/s12881-020-01160-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a highly heterogeneous genetic disorder caused by defects in motile cilia. The hallmark features of PCD are the chronic infections of the respiratory tract, moreover, clinical manifestations include also laterality defects and risk of male infertility. Clinical phenotypes of PCD are the result of mutations in genes encoding components of axonema or factors involved in axonemal assembly. Recent studies have identified over 45 PCD-associated genes, therefore, molecular analysis represents a powerful diagnostic tool to confirm and uncover new genetic causes of this rare disease. CASE PRESENTATION Here, we describe a female infant of Moroccan origin with normal pressure hydrocephalus (NPH) in addition to most common PCD symptoms. Transmission Electron Microscopy (TEM) and molecular tests, such as a Next generation Sequencing panel and a custom array CGH, were performed for diagnosis of PCD. TEM revealed outer dynein arm (ODA) defects, whilst molecular analyses detected a novel 6,9 kb microdeletion in DNAI2 gene. CONCLUSIONS Since DNAI2 mutations are very rare, this case report contributes to better delineate the important role of DNAI2 as causative of PCD phenotype, suggesting, furthermore, that the variations in DNAI2 may be as a new genetic risk factor for NPH. Indeed, although the association of hydrocephalus with PCD has been well documented, however, only a small number of human patients show this defect. Furthermore, this study highlights the importance of high-throughput technologies in advancing our understanding of heterogeneous genetic disorders.
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Affiliation(s)
- Maria Santa Rocca
- Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Gioia Piatti
- Unit of Bronchopneumology, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Angela Michelucci
- Laboratory of Molecular Genetics, University Hospital of Pisa, Pisa, Italy
| | - Raffaella Guazzo
- Unit of Pathological Anatomy, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Veronica Bertini
- Laboratory of Cytogenetics, University Hospital of Pisa, Pisa, Italy
| | - Cinzia Vinanzi
- Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | | | - Angelo Valetto
- Laboratory of Cytogenetics, University Hospital of Pisa, Pisa, Italy
| | - Carlo Foresta
- Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
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Suzaki I, Hirano K, Arai S, Maruyama Y, Mizuyoshi T, Tokudome T, Fujii N, Kobayashi H. Primary Ciliary Dyskinesia with Refractory Chronic Rhinosinusitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923270. [PMID: 32862191 PMCID: PMC7483516 DOI: 10.12659/ajcr.923270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 49-year-old Final Diagnosis: Situs inversus Symptoms: Cough • nasal congestion • nasal obstruction Medication:— Clinical Procedure: — Specialty: Otolaryngology
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Sawa Arai
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Yuki Maruyama
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Tomomi Mizuyoshi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Takatoshi Tokudome
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Naokazu Fujii
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
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Weinberger M, Hurvitz M. Diagnosis and management of chronic cough: similarities and differences between children and adults. F1000Res 2020; 9. [PMID: 32765833 PMCID: PMC7385707 DOI: 10.12688/f1000research.25468.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 11/20/2022] Open
Abstract
Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.
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Affiliation(s)
- Miles Weinberger
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | - Manju Hurvitz
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
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Knowledge of Rare Respiratory Diseases among Paediatricians and Medical School Students. J Clin Med 2020; 9:jcm9030869. [PMID: 32235794 PMCID: PMC7141530 DOI: 10.3390/jcm9030869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 12/05/2022] Open
Abstract
Alpha-1-antitrypsin deficiency (AATD) and primary ciliary dyskinesia (PCD) are underdiagnosed rare diseases showing a median diagnostic delay of five to ten years, which has negative effects on patient prognosis. Lack of awareness and education among healthcare professionals involved in the management of these patients have been suggested as possible causes. Our aim was to assess knowledge of these diseases among paediatricians and medical school students to determine which knowledge areas are most deficient. A survey was designed with questions testing fundamental aspects of the diagnosis and treatment of AATD and PCD. A score equal to or greater than 50% of the maximum score was set as the level necessary to ensure a good knowledge of both diseases. Our results indicate a profound lack of knowledge of rare respiratory diseases among paediatric professionals and medical students, suggesting that it is necessary to increase rare respiratory diseases training among all physicians responsible for suspecting and diagnosing them; this will allow early diagnosis and the setup of preventive measures and appropriate early-stage treatment. The first step in closing this knowledge gap could be to include relevant material in the medical syllabus.
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Armengot-Carceller M, Reula A, Mata-Roig M, Pérez-Panadés J, Milian-Medina L, Carda-Batalla C. Understanding Primary Ciliary Dyskinesia: Experience From a Mediterranean Diagnostic Reference Centre. J Clin Med 2020; 9:jcm9030810. [PMID: 32188167 PMCID: PMC7141270 DOI: 10.3390/jcm9030810] [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] [Received: 01/31/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Due to the lack of a gold standard diagnostic test, reference centres with experienced personnel and costly procedures are needed for primary ciliary dyskinesia (PCD) diagnostics. Diagnostic flowcharts always start with clinical symptoms. Therefore, the aim of this work is to define differential clinical criteria so that only patients clinically compatible with PCD are referred to reference centres. Materials and methods: 18 variables from 476 Mediterranean patients with clinically suspicious PCD were collected. After analysing cilia function and ultrastructure, 89 individuals were diagnosed with PCD and 387 had a negative diagnosis. Simple logistic regression analysis, considering PCD as a dependent variable and the others as independent variables, was done. In order to define the variables that best explain PCD, a step-wise logistic regression model was defined. Aiming to classify individuals as PCD or PCD-like patients, based on variables included in the study, a classification and regression tree (CART) was designed. Results and conclusions: Simple logistic regression analysis shows statistically significant association between age at the beginning of their symptomatology, periodicity, fertility, situs inversus, recurrent otitis, atelectasis, bronchiectasis, chronic productive cough, rhinorrea, rhinusinusitis and recurrent pneumonias, and PCD. The step-wise logistic regression model selected situs inversus, atelectasis, rhinorrea, chronic productive cough, bronchiectasis, recurrent pneumonias, and otitis as PCD predictive variables (82% sensitivity, 88% specificity, and 0.92 Area Under the Curve (AUC)). A decision tree was designed in order to classify new individuals based on pansinusitis, situs inversus, periodicity, rhinorrea, bronchiectasis, and chronic wet cough.
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Affiliation(s)
- Miguel Armengot-Carceller
- Surgery Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
- ENT Service, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
- Grupo de Biomedicina Molecular, Celular y Genómica IIS La Fe, 46026 Valencia, Spain
| | - Ana Reula
- Grupo de Biomedicina Molecular, Celular y Genómica IIS La Fe, 46026 Valencia, Spain
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (M.M.-R.); (L.M.-M.); (C.C.-B.)
- Correspondence:
| | - Manuel Mata-Roig
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (M.M.-R.); (L.M.-M.); (C.C.-B.)
| | - Jordi Pérez-Panadés
- Subdirección General de Epidemiología, Vigilancia de la Salud y Sanidad Ambiental, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, 46010 Valencia, Spain;
| | - Lara Milian-Medina
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (M.M.-R.); (L.M.-M.); (C.C.-B.)
| | - Carmen Carda-Batalla
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (M.M.-R.); (L.M.-M.); (C.C.-B.)
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Parras García de León N, Sacristán Bou L, Ordoñez Dios I, García Carreño E. [Repeated respiratory infections in a patient with Kartagener's Syndrome]. Rev Esp Geriatr Gerontol 2020; 55:54-55. [PMID: 31519464 DOI: 10.1016/j.regg.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - Lirios Sacristán Bou
- Servicio de Neumología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Isabel Ordoñez Dios
- Servicio de Neumología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Elena García Carreño
- Servicio de Geriatría, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Abstract
Cystic fibrosis (CF) lung disease is the major cause of morbidity and mortality in people with CF. Abnormal mucociliary transport has been the leading hypothesis for the underlying pathogenesis of CF airway disease. However, this has been difficult to investigate at very early time points. A porcine CF model, which recapitulates many features of CF disease in humans, enables studies to be performed in non-CF and CF pigs on the day that they are born. In newborn CF pigs, we found that under basal conditions, mucociliary transport rates in non-CF and CF pigs are similar. However, after cholinergic stimulation, which stimulates submucosal gland secretion, particles become stuck in the CF airways owing to a failure of mucus strands to release from submucosal glands. In this review, we summarize these recent discoveries and also discuss the morphology, composition, and function of mucins in the porcine lung.
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Keicho N, Hijikata M, Morimoto K, Homma S, Taguchi Y, Azuma A, Kudoh S. Primary ciliary dyskinesia caused by a large homozygous deletion including exons 1-4 of DRC1 in Japanese patients with recurrent sinopulmonary infection. Mol Genet Genomic Med 2019; 8:e1033. [PMID: 31701675 PMCID: PMC6978274 DOI: 10.1002/mgg3.1033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/26/2019] [Accepted: 10/16/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Diffuse panbronchiolitis (DPB) is a sinopulmonary disease mainly affecting Asian populations. Primary ciliary dyskinesia (PCD) is a genetically heterogeneous disorder impairing ciliary structure and function. These two disorders are not easily distinguished by clinical signs and symptoms. METHODS In 105 Japanese patients with recurrent sinopulmonary infection, initially diagnosed with DPB, and 37 patients with recurrent airway infection diagnosed in adulthood, the deletion allele of DRC1 or CCDC164, recently recognized as a pathogenic PCD gene variant, was searched using a multiplexed PCR-based method, and the deletion breakpoints and other variants around the gene were determined by Sanger sequencing and targeted resequencing. RESULTS A large homozygous deletion in DRC1 was identified in three of the 142 patients. Furthermore, heterozygous carriers of the deletion with the same breakpoint were found with the allele frequency of 0.002 in the healthy Japanese population, indicating that this loss-of-function variant may be acting as a common mutation causing PCD in Japanese. CONCLUSION PCD caused by the DRC1 defect is not readily identified by either high-speed video-microscopy or ciliary ultrastructure analysis, posing significant difficulties in reaching a correct diagnosis without the aid of genetic tests. Careful investigation of the causes of sinopulmonary diseases is warranted in Asian populations.
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Affiliation(s)
- Naoto Keicho
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Minako Hijikata
- Department of Pathophysiology and Host Defense, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Tokyo, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, Nara, Japan
| | - Arata Azuma
- Division of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, Tokyo, Japan
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Shapiro AJ, Davis SD, Polineni D, Manion M, Rosenfeld M, Dell SD, Chilvers MA, Ferkol TW, Zariwala MA, Sagel SD, Josephson M, Morgan L, Yilmaz O, Olivier KN, Milla C, Pittman JE, Daniels MLA, Jones MH, Janahi IA, Ware SM, Daniel SJ, Cooper ML, Nogee LM, Anton B, Eastvold T, Ehrne L, Guadagno E, Knowles MR, Leigh MW, Lavergne V. Diagnosis of Primary Ciliary Dyskinesia. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2019; 197:e24-e39. [PMID: 29905515 DOI: 10.1164/rccm.201805-0819st] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This document presents the American Thoracic Society clinical practice guidelines for the diagnosis of primary ciliary dyskinesia (PCD). TARGET AUDIENCE Clinicians investigating adult and pediatric patients for possible PCD. METHODS Systematic reviews and, when appropriate, meta-analyses were conducted to summarize all available evidence pertinent to our clinical questions. Evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for diagnosis and discussed by a multidisciplinary panel with expertise in PCD. Predetermined conflict-of-interest management strategies were applied, and recommendations were formulated, written, and graded exclusively by the nonconflicted panelists. Three conflicted individuals were also prohibited from writing, editing, or providing feedback on the relevant sections of the manuscript. RESULTS After considering diagnostic test accuracy, confidence in the estimates for each diagnostic test, relative importance of test results studied, desirable and undesirable direct consequences of each diagnostic test, downstream consequences of each diagnostic test result, patient values and preferences, costs, feasibility, acceptability, and implications for health equity, the panel made recommendations for or against the use of specific diagnostic tests as compared with using the current reference standard (transmission electron microscopy and/or genetic testing) for the diagnosis of PCD. CONCLUSIONS The panel formulated and provided a rationale for the direction as well as for the strength of each recommendation to establish the diagnosis of PCD.
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Individualized physical training in the therapy of Primary Ciliary Dyskinesia - A case report. Respir Med Case Rep 2019; 28:100925. [PMID: 31463189 PMCID: PMC6710229 DOI: 10.1016/j.rmcr.2019.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Primary Ciliary Dyskinesia (PCD) is an autosomal recessive disease, characterized by ciliary dysfunction and impaired mucociliary clearance. Previous studies have indicated a low physical fitness in PCD patients but currently it is not known whether physical training beneficially affects fitness, inflammatory markers and quality of life. Case presentation The patient was a Caucasian male (67.0 kg, 183.3 cm), born in 1984 and was diagnosed with the Kartagener Syndrome (i.e. PCD) right after birth. He was prescribed structured physical training over a period of almost two years (from August 2017-June 2019) and was assessed regularly. Aerobic fitness improved throughout the intervention period, but no systematic changes were observed in inflammatory markers and overall quality of life. Conclusions Our data provides reasoning to stress the implementation of structured physical training to enhance physical performance also in the management of PCD.
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Yue Y, Huang Q, Zhu P, Zhao P, Tan X, Liu S, Li S, Han X, Cheng L, Li B, Fu Y. Identification of Pathogenic Mutations and Investigation of the NOTCH Pathway Activation in Kartagener Syndrome. Front Genet 2019; 10:749. [PMID: 31507630 PMCID: PMC6713718 DOI: 10.3389/fgene.2019.00749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Primary ciliary dyskinesia (PCD), a rare genetic disorder, is mostly caused by defects in more than 40 known cilia structure-related genes. However, in approximately 20-35% of patients, it is caused by unknown genetic factors, and the inherited pathogenic factors are difficult to confirm. Kartagener syndrome (KTS) is a subtype of PCD associated with situs inversus, presenting more complex genetic heterogeneity. The aim of this study was to identify pathogenic mutations of candidate genes in Chinese patients with KTS and investigate the activation of the heterotaxy-related NOTCH pathway. Whole-exome sequencing was conducted in five patients with KTS. Pathogenic variants were identified using bioinformatics analysis. Candidate variants were validated by Sanger sequencing. The expression of the NOTCH pathway target genes was detected in patients with KTS. We identified 10 KTS-associated variants in six causative genes, namely, CCDC40, DNAH1, DNAH5, DNAH11, DNAI1, and LRRC6. Only one homozygote mutation was identified in LRRC6 (c.64dupT). Compound heterozygous mutations were found in DNAH1 and DNAH5. Six novel mutations were identified in four genes. Further analyses showed that the NOTCH pathway might be activated in patients with KTS. Overall, our study showed that compound heterozygous mutations widely exist in Chinese KTS patients. Our results demonstrated that the activation of the NOTCH pathway might play a role in the situs inversus pathogenicity of KTS. These findings highlight that Kartagener syndrome might be a complex genetic heterogeneous disorder mediated by heterozygous mutations in multiple PCD- or cilia-related genes.
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Affiliation(s)
- Yongjian Yue
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Qijun Huang
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Peng Zhu
- Central Lab of Shenzhen Pingshan People's Hospital, Shenzhen, China
| | - Pan Zhao
- Clinical Medical Research Center, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Xinjuan Tan
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Shengguo Liu
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Shulin Li
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Xuemei Han
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Linling Cheng
- State Key Laboratory of Respiration Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Li
- Department of Pediatric, First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Yingyun Fu
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
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Han SM, Hwang CS, Jeon HJ, Lee HY, Cho HJ, Park DJ. Three Cases of Primary Ciliary Dyskinesia Combined With Reduced Exhaled Nitric Oxide. Ann Otol Rhinol Laryngol 2019; 128:1081-1085. [PMID: 31271036 DOI: 10.1177/0003489419861119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The diagnosis of primary ciliary dyskinesia (PCD) is often delayed in part related to the limitations of the available diagnostic tests. We present 3 cases of PCD diagnosed using an exhaled nitric oxide (eNO) measurement. METHODS Three cases with a clinical phenotype consistent with PCD were evaluated using an eNO assay with additional transmission electron microscopy (TEM) and/or genetic panel testing. RESULTS One male and 2 female patients presented with common symptoms included recurrent respiratory infection from early childhood and a history of neonatal respiratory distress as term newborn. Two of them had situs inversus totalis. Fractional eNO measurement revealed extremely low NO levels, and subsequently, TEM analysis confirmed ciliary ultrastructural defects in all patients. One patient had compound heterozygous mutation of the PCD-causative gene (DNAH5) identified using next generation sequencing. CONCLUSION Our report stresses the reliability of eNO measurement in the diagnosis of PCD, accompanied by clinical phenotypes and additional diagnostic tools, such as TEM analysis and genetic testing.
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Affiliation(s)
- Sung Min Han
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Chi Sang Hwang
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Hyun Jong Jeon
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Ho Young Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Joon Park
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
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Critical Evaluation of Sinonasal Disease in 64 Adults with Primary Ciliary Dyskinesia. J Clin Med 2019; 8:jcm8050619. [PMID: 31067752 PMCID: PMC6571605 DOI: 10.3390/jcm8050619] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022] Open
Abstract
To date, no study precisely described ear, nose and throat (ENT) disease in adults with primary ciliary dyskinesia (PCD) and its relationship with ciliary function/ultrastructure. A retrospective study of standardized ENT data (exam, audiogram, sinus Computed tomography (CT), and bacteriology) was conducted in 64 adults with confirmed PCD who were followed in two ENT reference centers. Rhinorrhoea and hearing loss were the main symptoms. Symptom scores were higher in older patients. Nasal endoscopy was abnormal in all patients except one, showing nasal polyps in one-third of the patients and stagnant nasal mucus secretions in 87.5% of the patients. Sinus CT opacities were mainly incomplete and showed one-third of the patients with sinus hypoplasia and/or agenesis. Middle meatus mainly grew Haemophilus influenzae, Streptoccocus pneumoniae and Pseudomonas aeruginosa. Otitis media with effusion (OME), which is constant in childhood, was diagnosed in less than one-quarter of the patients. In two-thirds of the patients, audiogram showed hearing loss that was sensorineural in half of the patients. ENT disease severity was not correlated with ciliary function and ultrastructure, but the presence of OME was significantly associated with a forced expiratory volume (FEV1) < 70%. Rhinosinusitis is the most common clinical feature of PCD in adults, while OME is less frequent. The presence of active OME in adults with PCD could be a severity marker of lung function and lead to closer monitoring.
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Koo CH, Shim JK, Kim N, Ki Y, Park J, Kim JC. Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chang-hoon Koo
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namhoon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Yumin Ki
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Junbeom Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Jong Chan Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, Seongnam, Korea
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Gil HI, Lee T, Jeong BH, Lee H, Choe J, Ahn K, Hong SD, Jeon K, Koh WJ, Kim JS, Park HY. Additional role of bronchial mucosal biopsy for ciliary structural abnormality in diagnosis of primary ciliary dyskinesia. J Thorac Dis 2019; 11:839-847. [PMID: 31019772 DOI: 10.21037/jtd.2019.02.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Transmission electron microscopy (TEM) is one of diagnostic tests for primary ciliary dyskinesia (PCD). The mucosal samples obtained for cilia examination are generally procured from the nasal turbinate, but these specimens often yield inadequate results. The bronchial mucosa is recognized as an alternative sample, but no study has examined the additional utility of bronchial mucosa compared with nasal mucosa in the diagnosis of PCD. Methods The medical records of 96 patients who underwent TEM for suspected PCD between April 1997 and June 2017 were reviewed. Patients were divided into three groups based on the site of mucosal biopsy: nasal biopsy (NB) group with nasal mucosal biopsy only; bronchial biopsy (BB) group with bronchial mucosal biopsy only; and nasal and bronchial biopsy (NBB) group with a combination of nasal and bronchial mucosal biopsies. Results The rate of PCD diagnosis was 28.8% (17/59) in the NB group, 41.2% (7/17) in the BB group, and 60.0% (12/20) in the NBB group. The yield of PCD diagnosis significantly increased in the NBB group compared with the NB group (P=0.012). In the NBB group, 25.0% (5/20) of patients were diagnosed with PCD by nasal mucosal biopsy, and 35.0% (7/20) of patients were additionally diagnosed by bronchial mucosal biopsy. The presence of sinusitis or bronchiectasis was not associated with prediction of PCD diagnosis from nasal or bronchial mucosal biopsy. Conclusions The combination of nasal and bronchial mucosal biopsy for TEM showed higher yields of PCD diagnosis than nasal mucosal biopsy alone.
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Affiliation(s)
- Hyun-Il Gil
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taebum Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Hammoudeh S, Gadelhak W, Janahi IA. Primary ciliary dyskinesia among Arabs: Where do we go from here? Paediatr Respir Rev 2019; 29:19-22. [PMID: 30792130 DOI: 10.1016/j.prrv.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/05/2018] [Accepted: 09/07/2018] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia (PCD), also known as immotile-cilia syndrome, is a rare genetic disease that is inherited in an autosomal recessive manner. Several studies have explored certain aspects of PCD in the Arab world, yet much is still lacking in terms of identifying the different characteristics of this disease. In this paper, we aim to briefly cover those studies published about PCD in Arab countries, as well as to provide recommendations and guidelines for future studies.
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Affiliation(s)
- Samer Hammoudeh
- Medical Research Center, Research Affairs, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Wessam Gadelhak
- Medical Research Center, Research Affairs, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ibrahim A Janahi
- Medical Research Center, Research Affairs, Hamad Medical Corporation, PO Box 3050, Doha, Qatar; Pediatric Pulmonology, Sidra Medicine, PO Box 2699, Doha, Qatar.
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Viitanen SJ, Lappalainen AK, Koho NM, Pessa-Morikawa T, Ressel L, Rajamäki MM. Recurrent bacterial pneumonia in Irish Wolfhounds: Clinical findings and etiological studies. J Vet Intern Med 2019; 33:846-855. [PMID: 30666726 PMCID: PMC6430867 DOI: 10.1111/jvim.15413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increased incidence of bacterial pneumonia (BP) has been reported in Irish Wolfhounds (IWHs), and recurrence of BP is common. The etiology of recurrent pneumonia in IWHs is largely unknown. OBJECTIVES To describe clinical findings in IWHs with recurrent BP and investigate possible etiologies. ANIMALS Eleven affected IWHs, 25 healthy IWHs, 28 healthy dogs of other Sighthound breeds, and 16 healthy dogs of other breeds. METHODS Prospective cross-sectional observational study. All affected IWHs underwent thorough clinical examinations including thoracic radiographs, thoracic computed tomography, electron microscopic evaluation of ciliary structure, and bronchoscopy and bronchoalveolar lavage fluid (BALF) cytology and culture. Serum and BALF immunoglobulin concentrations were measured using an ELISA method, and peripheral blood lymphocyte subpopulations were analyzed using flow cytometry. Esophageal function was assessed by fluoroscopy (n = 2). RESULTS Median age of onset was 5.0 years (range, 0.4-6.5 years), and when presented for study, dogs had experienced a median of 5 previous episodes of BP (range, 2-6). The following predisposing factors to BP were detected: focal bronchiectasis (10/11), unilateral (2/9) and bilateral (1/9) laryngeal paralysis, and esophageal hypomotility (2/2). Local or systemic immunoglobulin deficiencies or primary ciliary defects were not detected. CONCLUSIONS AND CLINICAL IMPORTANCE Recurrent BP affects mostly middle-aged and older IWHs without any evident immune deficit or primary ciliary defects. Focal BE was a frequent finding in affected dogs and likely contributed to the development of recurrent respiratory infections. Laryngeal and esophageal dysfunction identified in a minority of dogs may contribute to recurrent BP.
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Affiliation(s)
- Sanna J Viitanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anu K Lappalainen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ninna M Koho
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Tiina Pessa-Morikawa
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Lorenzo Ressel
- Department of Veterinary Pathology and Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Minna M Rajamäki
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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CCDC114 is mutated in patient with a complex phenotype combining primary ciliary dyskinesia, sensorineural deafness, and renal disease. J Hum Genet 2018; 64:39-48. [PMID: 30291279 DOI: 10.1038/s10038-018-0514-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022]
Abstract
Ciliopathies-are widely recognized and associated with a wide variety of developmental and degenerative disorders. Most cilia-related diseases have renal manifestation, and there is a cross- overlapping relationship between gene mutations and cilia disease. Here, we investigated the clinical and pathological manifestation of a rare disease patient. We present the case of a 15-year-old child with dysplasia and multiple-organ damage who was initially diagnosed with nephrotic syndrome. The patient's kidney disease progressed to renal failure and received hemodialysis 10 months after renal biopsy. The individual presented primary ciliary dyskinesia (PCD) and additional symptoms including sensorineural deafness, kidney dysplasia, severe kidney function loss, and congenital heart disease which potentially linked to primary cilia deficiency. Cilia immunofluorescence of renal tissue showed a decrease in the number of cilium of the patient compared to the normal kidney. We identified a site mutation in CCDC114 (NM_144577 exon7 c. 596Cå T p. Ala199Val) by whole-exon sequences. We found that CCDC114 located at the basal body at cilia and the knockdown of CCDC114 could affect the occurrence of cilia in hRPE1 cells. The previous study of CCDC114 mainly lies in the motile cilia, and this study found that its impact on primary cilia thus broadened the understanding of overlapping function of different types of cilia.
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Ring AM, Buchvald FF, Holgersen MG, Green K, Nielsen KG. Fitness and lung function in children with primary ciliary dyskinesia and cystic fibrosis. Respir Med 2018; 139:79-85. [PMID: 29858006 DOI: 10.1016/j.rmed.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/26/2018] [Accepted: 05/01/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Peak oxygen uptake (VO2peak) is associated with morbidity and mortality in health and disease, and provides important information of global physical health not achieved from standard pulmonary function tests. Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are genetically determined diseases involving different basic defects, but both showing impaired mucociliary clearance leading to chronic infections and pulmonary destruction early in life. PCD is generally considered a milder disease than CF and it is hypothesized that children with CF would have consistently lower VO2peak and pulmonary function than children with PCD. METHODS We performed a prospective, observational single-center, clinical cohort study of VO2peak and pulmonary function in age and gender matched schoolchildren, at two occasions 12 months apart. RESULTS VO2peak was persistently (at baseline and after 12 months) and significantly reduced in the 22 patients with PCD (z-score = -0.89 and -1.0) and 24 with CF (z-score = -0.94 and -1.1), included in the study. Abnormal VO2peak was detected in a larger proportion of children with PCD (≈30%) than CF (≈13%). Moreover, children with PCD exhibited persistently lower FEV1 (p < 0.0001 at first visit and p = 0.001 at second visit) while FEF25-75 and FVC differed only at baseline. Indeed, a retrospective analysis comparing lung function over the last year in our entire PCD and CF populations between 6 and 18 years of age, revealed lower values in patients with PCD (FEV1 z-score, p = 0.0004, FVC z-score p < 0.0001, FEF25-75 z-score p = 0.008). CONCLUSION This is the first report indicating that cardiopulmonary fitness is equally and consistently reduced in both children with PCD and CF along with a consistent lower pulmonary function in PCD compared with CF. A certain reservation for possible selection bias and the small number of patients is necessary. However, increased focus on early diagnosis, evidence-based treatment regimens and close clinical monitoring in PCD are warranted.
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Affiliation(s)
- Astrid M Ring
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Frederik F Buchvald
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mathias G Holgersen
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kent Green
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kim G Nielsen
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Gallant JN, Basem JI, Turner JH, Shannon CN, Virgin FW. Nasal saline irrigation in pediatric rhinosinusitis: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 108:155-162. [PMID: 29605346 DOI: 10.1016/j.ijporl.2018.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the efficacy of nasal saline irrigation (NSI) in reducing symptoms and improving quality of life in pediatric patients with acute (ARS) or chronic (CRS) rhinosinusitis. DATA SOURCES We searched the PubMed/MEDLINE and Embase electronic databases (indexed January, 1950 through April, 2017). REVIEW METHODS Studies assessing the efficacy of NSI in pediatric patients with ARS or CRS were selected for analysis. Outcome measures, including symptom scores and parental surveys, were analyzed. Two independent reviewers evaluated each abstract and article. RESULTS Of the 272 articles identified using our search strategy, only 1 study, focusing on the use of NSI in pediatric ARS, met all inclusion criteria. No studies investigating NSI in pediatric CRS were included for analysis. In general, studies demonstrated significant improvement of symptom scores with the use of NSI in pediatric rhinosinusitis; but, the use of varied outcome measures, control treatments, and NSI delivery made including studies and drawing conclusions difficult. No quantitative meta-analysis could be performed. CONCLUSION NSI may provide benefit for ARS in children; however, additional high-quality studies with defined outcome measures are needed to determine the quantitative efficacy of this therapy in the pediatric patients with rhinosinusitis-especially in pediatric CRS.
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Affiliation(s)
| | - Jade I Basem
- Department of Neurological Surgery, United States
| | - Justin H Turner
- Department of Otolaryngology, Vanderbilt University, Nashville, TN, United States
| | | | - Frank W Virgin
- Department of Otolaryngology, Vanderbilt University, Nashville, TN, United States.
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Yang L, Banerjee S, Cao J, Bai X, Peng Z, Chen H, Huang H, Han P, Feng S, Yi N, Song X, Wu J. Compound Heterozygous Variants in the Coiled-Coil Domain Containing 40 Gene in a Chinese Family with Primary Ciliary Dyskinesia Cause Extreme Phenotypic Diversity in Cilia Ultrastructure. Front Genet 2018; 9:23. [PMID: 29456554 PMCID: PMC5801289 DOI: 10.3389/fgene.2018.00023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/17/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: Primary ciliary dyskinesia (PCD) is a rare genetic disorder manifested with recurrent infections of respiratory tract and infertility. Mutations in more than 20 genes including the Coiled-Coil Domain Containing 40 (CCDC40) gene are associated with PCD. A Chinese proband with a clinical diagnosis of PCD was analyzed for mutations in these genes to identify the genetic basis of the disease in the family. The proband showed altered mucociliary clearance of the airways, various degree of hyperemia and edema of the mucous membrane, left/right body asymmetry, infertility and ultrastructural abnormality of cilia in both sperm and bronchioles. Methods: The DNA from the proband was analyzed for genetic variation in a subset of genes known to cause PCD using targeted next generation sequencing in order to understand the molecular and genetic basis of the PCD in present family. The result of targeted next generation sequencing has been validated by Sanger sequencing and q-PCR. Results: Targeted next-generation sequencing identified two novel mutations (c.1259delA and EX17_20 deletion) in CCDC40 gene that causes abnormal CCDC40 mRNA expression. These two novel variants cause disorganization of axoneme filaments, which resulted in reduction of sperm motility and phenotypic diversity in ultrastructure of cilia in the proband. Conclusion: These findings highlight the significance of the mutations in CCDC40 as novel candidates for genetic testing in PCD patients as well as the key role of ICSI treatment for the families affected by this ciliary dysmotility. Our findings showed that our work enriched the performance of cilia ultrastructure which were not previously reported in PCD patients.
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Affiliation(s)
- Lin Yang
- Centre for Reproductive Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | | | - Jie Cao
- Department of Respiratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaohong Bai
- Centre for Reproductive Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhijun Peng
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haixia Chen
- Centre for Reproductive Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Huang
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Peng Han
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | | | - Na Yi
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Xueru Song
- Centre for Reproductive Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing Wu
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
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Primary Ciliary Dyskinesia Due to Microtubular Defects is Associated with Worse Lung Clearance Index. Lung 2018; 196:231-238. [PMID: 29368042 PMCID: PMC5854730 DOI: 10.1007/s00408-018-0086-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022]
Abstract
Purpose Primary ciliary dyskinesia (PCD) is characterised by repeated upper and lower respiratory tract infections, neutrophilic airway inflammation and obstructive airway disease. Different ultrastructural ciliary defects may affect lung function decline to different degrees. Lung clearance index (LCI) is a marker of ventilation inhomogeneity that is raised in some but not all patients with PCD. We hypothesised that PCD patients with microtubular defects would have worse (higher) LCI than other PCD patients. Methods Spirometry and LCI were measured in 69 stable patients with PCD. Age at testing, age at diagnosis, ethnicity, ciliary ultrastructure, genetic screening result and any growth of Pseudomonas aeruginosa was recorded. Results Lung clearance index was more abnormal in PCD patients with microtubular defects (median 10.24) than those with dynein arm defects (median 8.3, p = 0.004) or normal ultrastructure (median 7.63, p = 0.0004). Age is correlated with LCI, with older patients having worse LCI values (p = 0.03, r = 0.3). Conclusion This study shows that cilia microtubular defects are associated with worse LCI in PCD than dynein arm defects or normal ultrastructure. The patient’s age at testing is also associated with a higher LCI. Patients at greater risk of obstructive lung disease should be considered for more aggressive management. Differences between patient groups may potentially open avenues for novel treatments. Electronic supplementary material The online version of this article (10.1007/s00408-018-0086-x) contains supplementary material, which is available to authorized users.
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Rodriguez K, Gaston B, Wasman J, Marozkina N. Lessons From Unilateral Loss of Cilia: Early Nasal Nitric Oxide Gas Mixing and the Role of Sinus Patency in Determining Nasal Nitric Oxide. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2017; 10:1179550617746361. [PMID: 29276419 PMCID: PMC5734436 DOI: 10.1177/1179550617746361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022]
Abstract
Nasal nitric oxide (nNO) measurement is a diagnostic test for primary ciliary dyskinesia (PCD). Here, we have shown the development of unilateral PCD-like symptoms associated with low nNO. A 60-year-old man had been previously healthy but developed unilateral, severe pansinusitis. He required surgical drainage of all left sinuses, and biopsies showed loss of the ciliated epithelium. At 4 weeks, he had unilateral (left-sided), profuse, clear rhinorrhea characteristic of PCD, and his surgical ostia were all patent endoscopically. His left-sided nNO was less than the right side by 37 ± 1.2 nL/min; this difference decreased to 18 ± 0.87 nL/min at 5 weeks and was gone by 6 weeks when his symptoms resolved. Measurements of 2- and 10-second measurements, in addition to standard nNO measurements, identified this discordance. We conclude that nNO reflects, in part, the production of NO by the ciliated epithelium, not just in the absence or occlusion of sinuses. Early (nasal/sinus volume) measures may be better for diagnosing PCD in than standard, steady-state assays in certain populations.
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Affiliation(s)
- Kenneth Rodriguez
- Department of Otolaryngology, Case Western Reserve University, Cleveland, OH, USA
| | - Benjamin Gaston
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA.,Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Jay Wasman
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Nadzeya Marozkina
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
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Monocytes from patients with Primary Ciliary Dyskinesia show enhanced inflammatory properties and produce higher levels of pro-inflammatory cytokines. Sci Rep 2017; 7:14657. [PMID: 29116124 PMCID: PMC5676706 DOI: 10.1038/s41598-017-15027-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/18/2017] [Indexed: 01/21/2023] Open
Abstract
Patients with Primary Ciliary Dyskinesia (PCD) suffer from recurrent upper and lower airway infections due to defects in the cilia present on the respiratory epithelium. Since chronic inflammatory conditions can cause changes in innate immune responses, we investigated whether monocytes isolated from the peripheral blood of pediatric PCD patients respond differently to inflammatory stimuli, compared to monocytes from healthy children and adults. The receptor for C5a (C5aR) was upregulated in PCD, whereas expression levels of the leukocyte chemoattractant receptors CCR1, CCR2, CCR5, BLT1 and FPR1 on PCD monocytes were similar to those on monocytes from healthy individuals. Also in vitro migration of PCD monocytes towards the ligands of those receptors (CCL2, fMLP, C5a and LTB4) was normal. Compared to healthy children, PCD patients had a higher percentage of the non-classic monocyte subset (CD14+CD16++) in circulation. Finally, PCD monocytes produced higher levels of pro-inflammatory cytokines (IL-1β and TNF-α) and chemokines (CCL3, CCL5, CCL18 and CCL22) in response to LPS, peptidoglycan and/or dsRNA stimulation. These data suggest that monocytes might exacerbate inflammatory reactions in PCD patients and might maintain a positive feedback-loop feeding the inflammatory process.
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