1
|
Smallwood D, Ledford D, Kennedy D, Lockey R. Postnasal Drip. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1472-1478. [PMID: 38677587 DOI: 10.1016/j.jaip.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Postnasal drip (PND) is a common symptom encountered when evaluating subjects with sinonasal disease; it may be present without sinonasal disease or as a symptom of laryngopharyngeal reflux. It is postulated that PND stems from dysfunction of normal mucus clearance mechanisms; however, there is no definitive evidence elucidating an exact pathophysiology. Compounding the uncertainties surrounding PND is the lack of an objective assessment tool. Instead, treating physicians must rely on subjective complaints and investigators utilize validated patient-reported outcome instruments, such as the Sino-Nasal Outcome Test, to determine treatment efficacy. This review seeks to discuss the current understanding of PND and evidence regarding effective treatment strategies.
Collapse
Affiliation(s)
- Dalan Smallwood
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla.
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - David Kennedy
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Richard Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| |
Collapse
|
2
|
Takeuchi K, Abo M, Date H, Gotoh S, Kamijo A, Kaneko T, Keicho N, Kodama S, Koinuma G, Kondo M, Masuda S, Mori E, Morimoto K, Nagao M, Nakano A, Nakatani K, Nishida N, Nishikido T, Ohara H, Okinaka Y, Sakaida H, Shiraishi K, Suzaki I, Tojima I, Tsunemi Y, Kainuma K, Ota N, Takeno S, Fujieda S. Practical guide for the diagnosis and management of primary ciliary dyskinesia. Auris Nasus Larynx 2024; 51:553-568. [PMID: 38537559 DOI: 10.1016/j.anl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/30/2023] [Accepted: 02/01/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Primary ciliary dyskinesia (PCD) is a relatively rare genetic disorder that affects approximately 1 in 20,000 people. Approximately 50 genes are currently known to cause PCD. In light of differences in causative genes and the medical system in Japan compared with other countries, a practical guide was needed for the diagnosis and management of Japanese PCD patients. METHODS An ad hoc academic committee was organized under the Japanese Rhinologic Society to produce a practical guide, with participation by committee members from several academic societies in Japan. The practical guide including diagnostic criteria for PCD was approved by the Japanese Rhinologic Society, Japanese Society of Otolaryngology-Head and Neck Surgery, Japanese Respiratory Society, and Japanese Society of Pediatric Pulmonology. RESULTS The diagnostic criteria for PCD consist of six clinical features, six laboratory findings, differential diagnosis, and genetic testing. The diagnosis of PCD is categorized as definite, probable, or possible PCD based on a combination of the four items above. Diagnosis of definite PCD requires exclusion of cystic fibrosis and primary immunodeficiency, at least one of the six clinical features, and a positive result for at least one of the following: (1) Class 1 defect on electron microscopy of cilia, (2) pathogenic or likely pathogenic variants in a PCD-related gene, or (3) impairment of ciliary motility that can be repaired by correcting the causative gene variants in iPS cells established from the patient's peripheral blood cells. CONCLUSION This practical guide provides clinicians with useful information for the diagnosis and management of PCD in Japan.
Collapse
Affiliation(s)
- Kazuhiko Takeuchi
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | - Miki Abo
- Kanazawa University Health Service Center Respiratory Medicine, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Japan
| | - Shimpei Gotoh
- Department of Clinical Application, Center for iPS Cell, Research and Application, Kyoto University, Japan
| | | | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University, Japan
| | - Naoto Keicho
- The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan
| | | | - Goro Koinuma
- Department of Medical Subspecialties, Division of Pulmonology, National Center for Child Health and Development, Japan
| | - Mitsuko Kondo
- Department of Respiratory Medicine, Tokyo Women's Medical University, Japan
| | - Sawako Masuda
- Department of Otorhinolaryngology, National Hospital Organization Mie National Hospital, Japan
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University, Japan
| | - Kozo Morimoto
- Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Mizuho Nagao
- National Hospital Organization Mie National Hospital, Japan
| | - Atsuko Nakano
- Department of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | | | - Naoya Nishida
- Department of Otolaryngology, Ehime University, Japan
| | - Tomoki Nishikido
- Department of Pediatric Pulmonology and Allergy, Osaka Women's and Children's Hospital, Japan
| | - Hirotatsu Ohara
- Department of Otorhinolaryngology, Mito Kyodo General Hospital, Japan
| | - Yosuke Okinaka
- Department of Otorhinolaryngology, Yamaguchi University, Japan
| | - Hiroshi Sakaida
- Department of Otorhinolaryngology, Head & Neck Surgery, Mie University, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | | | - Isao Suzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Showa University, Japan
| | - Ichiro Tojima
- Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology, Dokkyo Medical University, Japan
| | | | - Nobuo Ota
- Department of Otorhinolaryngology, Tohoku Medical and Pharmaceutical University, Japan
| | - Sachio Takeno
- Department of Otolaryngology, Head and Neck Surgery, Hiroshima University, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, University of Fukui, Japan
| |
Collapse
|
3
|
Bricmont N, Bonhiver R, Benchimol L, Louis B, Papon JF, Monseur J, Donneau AF, Moermans C, Schleich F, Calmès D, Poirrier AL, Louis R, Seghaye MC, Kempeneers C. Temporal Stability of Ciliary Beating Post Nasal Brushing, Modulated by Storage Temperature. Diagnostics (Basel) 2023; 13:2974. [PMID: 37761341 PMCID: PMC10527713 DOI: 10.3390/diagnostics13182974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Primary ciliary dyskinesia is a heterogeneous, inherited motile ciliopathy in which respiratory cilia beat abnormally, and some ultrastructural ciliary defects and specific genetic mutations have been associated with particular ciliary beating alterations. Ciliary beating can be evaluated using digital high-speed videomicroscopy (DHSV). However, normal reference values, essential to assess ciliary beating in patients referred for a PCD diagnostic, vary between centres, as minor variations in protocols might influence ciliary beating. Consequently, establishment of normal values is essential for each PCD diagnostic centre. We aimed to evaluate whether delay after sampling, and temperature for conservation of respiratory ciliated samples, might modify assessments of ciliary beating. In total, 37 healthy nasal brushing samples of respiratory ciliated epithelia were collected. Video sequences were recorded at 37 °C immediately using DHSV. Then, the samples were divided and conserved at 4 °C or at room temperature (RT). Ciliated beating edges were then recorded at 37 °C, at 3 h and at 9 h post sampling. In six samples, recordings were continued up to 72 h after sampling. Ciliary beating was assessed manually by ciliary beat frequency (CBFM) and ciliary beat pattern (CBP). A semi-automatic software was used for quantitative analysis. Both CBF and CBP evaluated manually and by a semi-automated method were stable 9 h after sampling. CBFM was higher when evaluated using samples stored at RT than at 4 °C. CBP and the semi-automated evaluation of ciliary beating were not affected by storage temperature. When establishing normal references values, ciliary beating can be evaluated at 37 °C up to 9 h after nasal brushing, but the storage temperature modifies ciliary beating and needs to be controlled.
Collapse
Affiliation(s)
- Noemie Bricmont
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Division of Respirology, Department of Pediatrics, University Hospital Liège, 4000 Liège, Belgium
| | - Romane Bonhiver
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Division of Respirology, Department of Pediatrics, University Hospital Liège, 4000 Liège, Belgium
| | - Lionel Benchimol
- Department of ENT, University Hospital Liège, 4000 Liège, Belgium; (L.B.); (A.-L.P.)
| | - Bruno Louis
- Institut Mondor de Recherche Biomédicale, INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France; (B.L.); (J.-F.P.)
| | - Jean-François Papon
- Institut Mondor de Recherche Biomédicale, INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France; (B.L.); (J.-F.P.)
- ENT Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Justine Monseur
- Biostatistics and Research Method Center-Public Health Department, University of Liège, 4000 Liège, Belgium; (J.M.); (A.-F.D.)
| | - Anne-Françoise Donneau
- Biostatistics and Research Method Center-Public Health Department, University of Liège, 4000 Liège, Belgium; (J.M.); (A.-F.D.)
| | - Catherine Moermans
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Department of Pneumology, University Hospital Liège, 4000 Liège, Belgium;
| | - Florence Schleich
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Department of Pneumology, University Hospital Liège, 4000 Liège, Belgium;
| | - Doriane Calmès
- Department of Pneumology, University Hospital Liège, 4000 Liège, Belgium;
| | - Anne-Lise Poirrier
- Department of ENT, University Hospital Liège, 4000 Liège, Belgium; (L.B.); (A.-L.P.)
| | - Renaud Louis
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Department of Pneumology, University Hospital Liège, 4000 Liège, Belgium;
| | - Marie-Christine Seghaye
- Division of Cardiology, Department of Pediatrics, University Hospital Liège, University of Liège, 4000 Liège, Belgium;
| | - Céline Kempeneers
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium; (R.B.); (C.M.); (F.S.); (R.L.); (C.K.)
- Division of Respirology, Department of Pediatrics, University Hospital Liège, 4000 Liège, Belgium
| |
Collapse
|
4
|
Butt SRR, Shakoor H, Khan TJ, Almaalouli B, Ekhator C, Ansari S, Shaikh N, Shehryar A, Rehman A. A Rare Case of Kartagener Syndrome Presenting with Sinusitis, Situs Inversus, and Bronchiectasis: Emphasizing Early Diagnosis and Management Strategies. Cureus 2023; 15:e41890. [PMID: 37457605 PMCID: PMC10348689 DOI: 10.7759/cureus.41890] [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: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Primary ciliary dyskinesia (PCDs), a subset of ciliary motility disorders, includes the rare hereditary illness Kartagener syndrome (KS). Sinusitis, situs inversus, and bronchiectasis, brought on by aberrant ciliary activity, are its defining features. We describe a case of an 18-year-old female with a history of recurrent respiratory complaints and chronic sinusitis. Additional testing confirmed the diagnosis of KS by identifying situs inversus, chronic bronchiectasis, and nasal polyps. This instance emphasizes the value of prompt KS diagnosis and treatment to avoid consequences. Supportive pulmonary care, antibiotics, and chest physical therapy are frequently employed, despite the lack of therapeutic standards. To further understand and manage this illness, more research is required. Patients with recurrent respiratory infections and structural lung disease can identify KS early.
Collapse
Affiliation(s)
- Samia Rauf R Butt
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hassan Shakoor
- Internal Medicine, Fauji Foundation Hospital Islamabad, Islamabad, PAK
| | - Tayyaba J Khan
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Safa Ansari
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Nehal Shaikh
- Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | | | | |
Collapse
|
5
|
Wei S, Xie H, Cheng Y. Progress in diagnosis of primary ciliary dyskinesia. J Paediatr Child Health 2022; 58:1736-1740. [PMID: 36069395 DOI: 10.1111/jpc.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
Primary ciliary dyskinesia (PCD) is an autosomal recessive genetic disorder characterised by motor ciliary dysfunction. The main manifestations are bronchiectasis, chronic sinusitis and situs inversus (viscera translocation triad). Additionally, it can present as male infertility and female ectopic pregnancy. However, there is currently no recognised diagnostic standard for PCD, which brings great challenges to its diagnosis and treatment. In addition to clinical data, the current diagnostic methods of PCD mainly include PICADAR, nasal exhaled nitric oxide, transmission electron microscopy, high-resolution immunofluorescence, high-speed video microscopy analysis and gene detection. This article makes a comprehensive comparison of the above diagnostic methods and suggests that genetic detection technology will become the general trend of PCD diagnosis.
Collapse
Affiliation(s)
- Shuna Wei
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haojun Xie
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yuanxiong Cheng
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
6
|
Bricmont N, Alexandru M, Louis B, Papon JF, Kempeneers C. Ciliary Videomicroscopy: A Long Beat from the European Respiratory Society Guidelines to the Recognition as a Confirmatory Test for Primary Ciliary Dyskinesia. Diagnostics (Basel) 2021; 11:diagnostics11091700. [PMID: 34574040 PMCID: PMC8471803 DOI: 10.3390/diagnostics11091700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare inherited ciliopathy in which respiratory cilia are stationary or dyskinetic. The clinical presentation of PCD is highly non-specific since it includes infections and disorders of the upper (otitis and rhinosinusitis) and lower (neonatal respiratory distress, bronchitis, pneumonia and bronchiectasis) airways, starting in early life. Clinical examination alone does not allow a PCD diagnosis, which relies on several concordant tests, since none are sensitive or specific enough alone. Despite being the most sensitive and specific test to diagnose PCD, digital high-speed videomicroscopy (DHSV) is not sufficiently standardized, preventing its use with complete confidence as a confirmatory diagnostic test for PCD, or its inclusion in a diagnostic algorithm. Since the 2017 ERS recommendations for PCD diagnosis, three main issues remain to be solved in order to optimize DHSV ciliary beating evaluation: the problem in defining an accurate sensitivity and specificity as there is no gold standard method to diagnose all PCD cases, a lack of standardization in the operating procedure for processing respiratory samples, and in the choice of measured parameters (self-operating or not). The development of new automated analysis approaches is promising and will require full clinical validation.
Collapse
Affiliation(s)
- Noemie Bricmont
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium;
- Correspondence:
| | - Mihaela Alexandru
- ENT Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France; (M.A.); (J.-F.P.)
| | - Bruno Louis
- Institut Mondor de Recherche Biomédicale INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France;
| | - Jean-François Papon
- ENT Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France; (M.A.); (J.-F.P.)
- Institut Mondor de Recherche Biomédicale INSERM-UPEC UMR 955, CNRS ERL7000, 94010 Créteil, France;
| | - Céline Kempeneers
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, 4000 Liège, Belgium;
- Division of Respirology, Department of Pediatrics, University Hospital Liège, 4000 Liège, Belgium
| |
Collapse
|
7
|
Sampaio P, da Silva MF, Vale I, Roxo-Rosa M, Pinto A, Constant C, Pereira L, Quintão CM, Lopes SS. CiliarMove: new software for evaluating ciliary beat frequency helps find novel mutations by a Portuguese multidisciplinary team on primary ciliary dyskinesia. ERJ Open Res 2021; 7:00792-2020. [PMID: 34104642 PMCID: PMC8174773 DOI: 10.1183/23120541.00792-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
Evaluation of ciliary beat frequency (CBF) performed by high-speed videomicroscopy analysis (HVMA) is one of the techniques required for the correct diagnosis of primary ciliary dyskinesia (PCD). Currently, due to lack of open-source software, this technique is widely performed by visually counting the ciliary beatings per a given time-window. Our aim was to generate open-source, fast and intuitive software for evaluating CBF, validated in Portuguese PCD patients and healthy volunteers. Nasal brushings collected from 17 adult healthy volunteers and 34 PCD-referred subjects were recorded using HVMA. Evaluation of CBF was compared by two different methodologies: the new semi-automated computer software CiliarMove and the manual observation method using slow-motion movies. Clinical history, nasal nitric oxide and transmission electron microscopy were performed for diagnosis of PCD in the patient group. Genetic analysis was performed in a subset (n=8) of suspected PCD patients. The correlation coefficient between the two methods was R2=0.9895. The interval of CBF values obtained from the healthy control group (n=17) was 6.18-9.17 Hz at 25°C. In the PCD-excluded group (n=16), CBF ranged from 6.84 to 10.93 Hz and in the PCD group (n=18), CBF ranged from 0 to 14.30 Hz. We offer an automated open-source programme named CiliarMove, validated by the manual observation method in a healthy volunteer control group, a PCD-excluded group and a PCD-confirmed group. In our hands, comparisons between CBF intervals alone could discern between healthy and PCD groups in 78% of the cases.
Collapse
Affiliation(s)
- Pedro Sampaio
- iNOVA4HEALTH, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Mónica Ferro da Silva
- iNOVA4HEALTH, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Inês Vale
- Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, Caparica, Portugal
| | - Mónica Roxo-Rosa
- iNOVA4HEALTH, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Andreia Pinto
- iNOVA4HEALTH, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carolina Constant
- Unidade de Pneumologia Pediátrica, Departamento de Pediatria, Hospital de Santa Maria CHLN, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Luisa Pereira
- Unidade de Pneumologia Pediátrica, Departamento de Pediatria, Hospital de Santa Maria CHLN, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Carla M Quintão
- Departamento de Física, Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa, Monte da Caparica, Caparica, Portugal
- NOVA Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Lisboa, Portugal
| | - Susana S Lopes
- iNOVA4HEALTH, CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
8
|
Gileles-Hillel A, Mor-Shaked H, Shoseyov D, Reiter J, Tsabari R, Hevroni A, Cohen-Cymberknoh M, Amirav I, Brammli-Greenberg S, Horani A, Kerem E, Breuer O. Whole-exome sequencing accuracy in the diagnosis of primary ciliary dyskinesia. ERJ Open Res 2020; 6:00213-2020. [PMID: 33447612 PMCID: PMC7792814 DOI: 10.1183/23120541.00213-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023] Open
Abstract
The diagnosis of primary ciliary dyskinesia (PCD) relies on clinical features and sophisticated studies. The detection of bi-allelic disease-causing variants confirms the diagnosis. However, a standardised genetic panel is not widely available and new disease-causing genes are continuously identified. To assess the accuracy of untargeted whole-exome sequencing (WES) as a diagnostic tool for PCD, patients with symptoms highly suggestive of PCD were consecutively included. Patients underwent measurement of nasal nitric oxide (nNO) levels, ciliary transmission electron microscopy analysis (TEM) and WES. A confirmed PCD diagnosis in symptomatic patients was defined as a recognised ciliary ultrastructural defect on TEM and/or two pathogenic variants in a known PCD-causing gene. Forty-eight patients (46% male) were enrolled, with a median age of 10.0 years (range 1.0–37 years). In 36 patients (75%) a diagnosis of PCD was confirmed, of which 14 (39%) patients had normal TEM. A standalone untargeted WES had a diagnostic yield of 94%, identifying bi-allelic variants in 11 known PCD-causing genes in 34 subjects. A nNO<77 nL·min was nonspecific when including patients younger than 5 years (area under the receiver operating characteristic curve (AUC) 0.75, 95% CI 0.60–0.90). Consecutive WES considerably improved the diagnostic accuracy of nNO in young children (AUC 0.97, 95% CI 0.93–1). Finally, WES established an alternative diagnosis in four patients. In patients with clinically suspected PCD and low nNO levels, WES is a simple, beneficial and accurate next step to confirm the diagnosis of PCD or suggest an alternative diagnosis, especially in preschool-aged children in whom nNO is less specific. Untargeted whole-exome sequencing in subjects with clinical symptoms highly suggestive of PCD has an excellent diagnostic accuracy and, as prices drop, may be the genetic test of choice for confirming PCD or establishing an alternative diagnosishttps://bit.ly/3j2jMbu
Collapse
Affiliation(s)
- Alex Gileles-Hillel
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hagar Mor-Shaked
- Monique and Jacques Roboh Department of Genetic Research, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Joel Reiter
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Israel Amirav
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Pediatric Pulmonology Unit, Tel Aviv, Israel
| | - Shuli Brammli-Greenberg
- The Department of Management, Policy and Health Economics, School of Public Health, The Hebrew University of Jerusalem, Israel
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
9
|
Lee SL, O'Callaghan C, Lau YL, Lee CWD. Functional analysis and evaluation of respiratory cilia in healthy Chinese children. Respir Res 2020; 21:259. [PMID: 33036612 PMCID: PMC7545929 DOI: 10.1186/s12931-020-01506-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To aid in the diagnosis of Primary Ciliary Dyskinesia (PCD) and to evaluate the respiratory epithelium in respiratory disease, normal age-related reference ranges are needed for ciliary beat frequency (CBF), beat pattern and ultrastructure. Our aim was to establish reference ranges for healthy Chinese children. METHODS Ciliated epithelial samples were obtained from 135 healthy Chinese children aged below 18 years by brushing the inferior nasal turbinate. CBF and beat pattern were analysed from high speed video recordings. Epithelial integrity and ciliary ultrastructure were assessed using transmission electronic microscopy. RESULTS The mean CBF from 135 children studied was 10.1 Hz (95% CI 9.8 to 10.4). Approximately 20% (ranged 18.0-24.2%) of ciliated epithelial edges were found to have areas of dyskinetically beating cilia. Normal beat pattern was observed in ciliated epithelium from all subjects. We did not find any effect of exposure to second hand smoke on CBF in our subjects. Microtubular defects were found in 9.3% of all of the cilia counted in these children, while other ciliary ultrastructural defects were found in less than 3%. CONCLUSIONS We established the reference range for CBF, beat pattern and ultrastructure in healthy Chinese children. Using similar methodology, we found a lower overall mean CBF than previously obtained European values. This study highlights the need to establish normative data for ciliary function in different populations.
Collapse
Affiliation(s)
- So-Lun Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, HKSAR, China. .,Department of Paediatrics and Adolescent Medicine, Duchess of Kent Children's Hospital, HKSAR, China.
| | - Christopher O'Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health and GOSH NIHR BRC, London, UK
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, HKSAR, China
| | - Chun-Wai Davy Lee
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, HKSAR, China
| |
Collapse
|
10
|
Abstract
Motile cilia are highly complex hair-like organelles of epithelial cells lining the surface of various organ systems. Genetic mutations (usually with autosomal recessive inheritance) that impair ciliary beating cause a variety of motile ciliopathies, a heterogeneous group of rare disorders. The pathogenetic mechanisms, clinical symptoms and severity of the disease depend on the specific affected genes and the tissues in which they are expressed. Defects in the ependymal cilia can result in hydrocephalus, defects in the cilia in the fallopian tubes or in sperm flagella can cause female and male subfertility, respectively, and malfunctional motile monocilia of the left-right organizer during early embryonic development can lead to laterality defects such as situs inversus and heterotaxy. If mucociliary clearance in the respiratory epithelium is severely impaired, the disorder is referred to as primary ciliary dyskinesia, the most common motile ciliopathy. No single test can confirm a diagnosis of motile ciliopathy, which is based on a combination of tests including nasal nitric oxide measurement, transmission electron microscopy, immunofluorescence and genetic analyses, and high-speed video microscopy. With the exception of azithromycin, there is no evidence-based treatment for primary ciliary dyskinesia; therapies aim at relieving symptoms and reducing the effects of reduced ciliary motility.
Collapse
|
11
|
Hamilton NJI, Lee DDH, Gowers KHC, Butler CR, Maughan EF, Jevans B, Orr JC, McCann CJ, Burns AJ, MacNeil S, Birchall MA, O'Callaghan C, Hynds RE, Janes SM. Bioengineered airway epithelial grafts with mucociliary function based on collagen IV- and laminin-containing extracellular matrix scaffolds. Eur Respir J 2020; 55:1901200. [PMID: 32444408 PMCID: PMC7301290 DOI: 10.1183/13993003.01200-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
Current methods to replace damaged upper airway epithelium with exogenous cells are limited. Existing strategies use grafts that lack mucociliary function, leading to infection and the retention of secretions and keratin debris. Strategies that regenerate airway epithelium with mucociliary function are clearly desirable and would enable new treatments for complex airway disease.Here, we investigated the influence of the extracellular matrix (ECM) on airway epithelial cell adherence, proliferation and mucociliary function in the context of bioengineered mucosal grafts. In vitro, primary human bronchial epithelial cells (HBECs) adhered most readily to collagen IV. Biological, biomimetic and synthetic scaffolds were compared in terms of their ECM protein content and airway epithelial cell adherence.Collagen IV and laminin were preserved on the surface of decellularised dermis and epithelial cell attachment to decellularised dermis was greater than to the biomimetic or synthetic alternatives tested. Blocking epithelial integrin α2 led to decreased adherence to collagen IV and to decellularised dermis scaffolds. At air-liquid interface (ALI), bronchial epithelial cells cultured on decellularised dermis scaffolds formed a differentiated respiratory epithelium with mucociliary function. Using in vivo chick chorioallantoic membrane (CAM), rabbit airway and immunocompromised mouse models, we showed short-term preservation of the cell layer following transplantation.Our results demonstrate the feasibility of generating HBEC grafts on clinically applicable decellularised dermis scaffolds and identify matrix proteins and integrins important for this process. The long-term survivability of pre-differentiated epithelia and the relative merits of this approach against transplanting basal cells should be assessed further in pre-clinical airway transplantation models.
Collapse
Affiliation(s)
- Nick J I Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, UK
- Nick J.I. Hamilton and Sam M. Janes are joint-senior authors
| | - Dani Do Hyang Lee
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate H C Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Elizabeth F Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Benjamin Jevans
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jessica C Orr
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Conor J McCann
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alan J Burns
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sheila MacNeil
- Dept of Materials and Science Engineering, The Kroto Research Institute, North Campus, University of Sheffield, Sheffield, UK
| | - Martin A Birchall
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, UK
| | - Christopher O'Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Nick J.I. Hamilton and Sam M. Janes are joint-senior authors
| |
Collapse
|
12
|
Blanchon S, Legendre M, Bottier M, Tamalet A, Montantin G, Collot N, Faucon C, Dastot F, Copin B, Clement A, Filoche M, Coste A, Amselem S, Escudier E, Papon JF, Louis B. Deep phenotyping, including quantitative ciliary beating parameters, and extensive genotyping in primary ciliary dyskinesia. J Med Genet 2019; 57:237-244. [DOI: 10.1136/jmedgenet-2019-106424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/20/2019] [Accepted: 10/13/2019] [Indexed: 11/04/2022]
Abstract
BackgroundPrimary ciliary dyskinesia (PCD) is a rare genetic disorder resulting in abnormal ciliary motility/structure, extremely heterogeneous at genetic and ultrastructural levels. We aimed, in light of extensive genotyping, to identify specific and quantitative ciliary beating anomalies, according to the ultrastructural phenotype.MethodsWe prospectively included 75 patients with PCD exhibiting the main five ultrastructural phenotypes (n=15/group), screened all corresponding PCD genes and measured quantitative beating parameters by high-speed video-microscopy (HSV).ResultsSixty-eight (91%) patients carried biallelic mutations. Combined outer/inner dynein arms (ODA/IDA) defect induces total ciliary immotility, regardless of the gene involved. ODA defect induces a residual beating with dramatically low ciliary beat frequency (CBF) related to increased recovery stroke and pause durations, especially in case of DNAI1 mutations. IDA defect with microtubular disorganisation induces a low percentage of beating cilia with decreased beating angle and, in case of CCDC39 mutations, a relatively conserved mean CBF with a high maximal CBF. Central complex defect induces nearly normal beating parameters, regardless of the gene involved, and a gyrating motion in a minority of ciliated edges, especially in case of RSPH1 mutations. PCD with normal ultrastructure exhibits heterogeneous HSV values, but mostly an increased CBF with an extremely high maximal CBF.ConclusionQuantitative HSV analysis in PCD objectives beating anomalies associated with specific ciliary ultrastructures and genotypes. It represents a promising approach to guide the molecular analyses towards the best candidate gene(s) to be analysed or to assess the pathogenicity of the numerous sequence variants identified by next-generation-sequencing.
Collapse
|
13
|
|
14
|
Kempeneers C, Seaton C, Garcia Espinosa B, Chilvers MA. Ciliary functional analysis: Beating a path towards standardization. Pediatr Pulmonol 2019; 54:1627-1638. [PMID: 31313529 DOI: 10.1002/ppul.24439] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 12/24/2022]
Abstract
Primary ciliary dyskinesia is an inherited disorder in which respiratory cilia are stationary, or beat in a slow or dyskinetic manner, leading to impaired mucociliary clearance and significant sinopulmonary disease. One diagnostic test is ciliary functional analysis using digital high-speed video microscopy (DHSV), which allows real-time analysis of complete ciliary function, comprising ciliary beat frequency (CBF) and ciliary beat pattern (CBP). However, DHSV lacks standardization. In this paper, the current knowledge of DHSV ciliary functional analysis is presented, and recommendations given for a standardized protocol for ciliary sample collection and processing. A proposal is presented for a quantitative and qualitative CBP evaluation system, to be used to develop international consensus agreement, and future DHSV research areas are identified.
Collapse
Affiliation(s)
- Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Claire Seaton
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bernardo Garcia Espinosa
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Mark A Chilvers
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
15
|
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: 269] [Impact Index Per Article: 53.8] [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.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Bonnefoy S, Watson CM, Kernohan KD, Lemos M, Hutchinson S, Poulter JA, Crinnion LA, Berry I, Simmonds J, Vasudevan P, O'Callaghan C, Hirst RA, Rutman A, Huang L, Hartley T, Grynspan D, Moya E, Li C, Carr IM, Bonthron DT, Leroux M, Boycott KM, Bastin P, Sheridan EG. Biallelic Mutations in LRRC56, Encoding a Protein Associated with Intraflagellar Transport, Cause Mucociliary Clearance and Laterality Defects. Am J Hum Genet 2018; 103:727-739. [PMID: 30388400 PMCID: PMC6218757 DOI: 10.1016/j.ajhg.2018.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/01/2018] [Indexed: 01/15/2023] Open
Abstract
Primary defects in motile cilia result in dysfunction of the apparatus responsible for generating fluid flows. Defects in these mechanisms underlie disorders characterized by poor mucus clearance, resulting in susceptibility to chronic recurrent respiratory infections, often associated with infertility; laterality defects occur in about 50% of such individuals. Here we report biallelic variants in LRRC56 (known as oda8 in Chlamydomonas) identified in three unrelated families. The phenotype comprises laterality defects and chronic pulmonary infections. High-speed video microscopy of cultured epithelial cells from an affected individual showed severely dyskinetic cilia but no obvious ultra-structural abnormalities on routine transmission electron microscopy (TEM). Further investigation revealed that LRRC56 interacts with the intraflagellar transport (IFT) protein IFT88. The link with IFT was interrogated in Trypanosoma brucei. In this protist, LRRC56 is recruited to the cilium during axoneme construction, where it co-localizes with IFT trains and is required for the addition of dynein arms to the distal end of the flagellum. In T. brucei carrying LRRC56-null mutations, or a variant resulting in the p.Leu259Pro substitution corresponding to the p.Leu140Pro variant seen in one of the affected families, we observed abnormal ciliary beat patterns and an absence of outer dynein arms restricted to the distal portion of the axoneme. Together, our findings confirm that deleterious variants in LRRC56 result in a human disease and suggest that this protein has a likely role in dynein transport during cilia assembly that is evolutionarily important for cilia motility.
Collapse
Affiliation(s)
- Serge Bonnefoy
- Trypanosome Cell Biology Unit & INSERM U1201, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Christopher M Watson
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK; School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Kristin D Kernohan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Moara Lemos
- Trypanosome Cell Biology Unit & INSERM U1201, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - Sebastian Hutchinson
- Trypanosome Cell Biology Unit & INSERM U1201, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France
| | - James A Poulter
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Laura A Crinnion
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK; School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Ian Berry
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Jennifer Simmonds
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Pradeep Vasudevan
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, RKCSB, University of Leicester, Leicester LE2 7LX, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, RKCSB, University of Leicester, Leicester LE2 7LX, UK; Respiratory, Critical Care & Anaesthesia, Institute of Child Health, University College London & Great Ormond Street Children's Hospital, 30 Guilford Street, London WC1N 1EH, UK
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, RKCSB, University of Leicester, Leicester LE2 7LX, UK
| | - Andrew Rutman
- Centre for PCD Diagnosis and Research, Department of Infection, Immunity and Inflammation, RKCSB, University of Leicester, Leicester LE2 7LX, UK
| | - Lijia Huang
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - David Grynspan
- Department of Pathology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Eduardo Moya
- Bradford Royal Infirmary, Bradford, West Yorkshire BD9 6R, UK
| | - Chunmei Li
- Department of Molecular Biology and Biochemistry, and Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada
| | - Ian M Carr
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK
| | - David T Bonthron
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK; School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Michel Leroux
- Department of Molecular Biology and Biochemistry, and Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Philippe Bastin
- Trypanosome Cell Biology Unit & INSERM U1201, Institut Pasteur, 25, rue du Docteur Roux, 75015 Paris, France.
| | - Eamonn G Sheridan
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds LS9 7TF, UK; School of Medicine, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK.
| |
Collapse
|
18
|
O’Callaghan C, Rutman A, Williams G, Kulkarni N, Hayes J, Hirst RA. Ciliated conical epithelial cell protrusions point towards a diagnosis of primary ciliary dyskinesia. Respir Res 2018; 19:125. [PMID: 29940967 PMCID: PMC6019300 DOI: 10.1186/s12931-018-0782-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary ciliary dyskinesia can result from a number of different ciliary defects that adversely affect ciliary function resulting markedly reduced or absent mucociliary clearance. Improvement in diagnostic testing is an area of current research. During diagnostic evaluation of PCD we observed ciliated conical protrusions from part of the apical surface of ciliated cells in those diagnosed with PCD. The aim of this study was to investigate if this abnormality was specific to PCD. METHODS Epithelial edges from 67 consecutively diagnosed PCD patients, 67 patients consecutively referred for PCD diagnostic testing in whom PCD was excluded, 22 with asthma and 18 with Cystic Fibrosis (CF) were studied retrospectively in a blinded manner using light microscopy. RESULTS Forty six out of 67 patients with PCD had ciliated conical epithelial protrusions, whereas none were seen in patients where PCD was excluded, or in patients with asthma or CF. The sensitivity, specificity, positive predictive value and negative predictive value for the presence of the ciliated conical protrusions to predict a diagnosis of PCD were 76.5, 100, 100 and 77% respectively. CONCLUSIONS Characteristic ciliated conical protrusions from ciliated epithelial cells maybe a useful pointer to the diagnosis of PCD. However, their absence does not exclude the diagnosis of PCD.
Collapse
Affiliation(s)
- Chris O’Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health & Great Ormond Street Children’s Hospital & NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, London, WC1N 1EH UK
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| | - Andrew Rutman
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| | - Gwyneth Williams
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| | - Neeta Kulkarni
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| | - Joseph Hayes
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| | - Robert A. Hirst
- Department of Infection, Centre for PCD Diagnosis and Research, Immunity and Inflammation, RKCSB, University of Leicester, Leicester, LE2 7LX UK
| |
Collapse
|
19
|
Lucas JS, Walker WT. NO way! Nasal nitric oxide measurement in infants. Eur Respir J 2018; 51:51/6/1800958. [DOI: 10.1183/13993003.00958-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/07/2018] [Indexed: 12/29/2022]
|
20
|
Peabody JE, Shei RJ, Bermingham BM, Phillips SE, Turner B, Rowe SM, Solomon GM. Seeing cilia: imaging modalities for ciliary motion and clinical connections. Am J Physiol Lung Cell Mol Physiol 2018; 314:L909-L921. [PMID: 29493257 DOI: 10.1152/ajplung.00556.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The respiratory tract is lined with multiciliated epithelial cells that function to move mucus and trapped particles via the mucociliary transport apparatus. Genetic and acquired ciliopathies result in diminished mucociliary clearance, contributing to disease pathogenesis. Recent innovations in imaging technology have advanced our understanding of ciliary motion in health and disease states. Application of imaging modalities including transmission electron microscopy, high-speed video microscopy, and micron-optical coherence tomography could improve diagnostics and be applied for precision medicine. In this review, we provide an overview of ciliary motion, imaging modalities, and ciliopathic diseases of the respiratory system including primary ciliary dyskinesia, cystic fibrosis, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis.
Collapse
Affiliation(s)
- Jacelyn E Peabody
- Department of Medicine, University of Alabama at Birmingham, Alabama.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham , Birmingham, Alabama
| | - Ren-Jay Shei
- Department of Medicine, University of Alabama at Birmingham, Alabama.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham , Birmingham, Alabama
| | | | - Scott E Phillips
- Department of Medicine, University of Alabama at Birmingham, Alabama
| | - Brett Turner
- Departments of Pediatrics and Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Alabama
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Alabama.,Departments of Pediatrics and Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Alabama.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham , Birmingham, Alabama
| | - George M Solomon
- Department of Medicine, University of Alabama at Birmingham, Alabama.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham , Birmingham, Alabama
| |
Collapse
|
21
|
Knowles MR, Leigh MW. Primary Ciliary Dyskinesia Diagnosis. Is Color Better Than Black and White? Am J Respir Crit Care Med 2017; 196:9-10. [PMID: 28665204 DOI: 10.1164/rccm.201702-0426ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Michael R Knowles
- 1 Marsico Lung Institute: Cystic Fibrosis/Pulmonary Research and Treatment Center University of North Carolina Chapel Hill, North Carolina and
| | - Margaret W Leigh
- 2 Department of Pediatrics University of North Carolina Chapel Hill, North Carolina
| |
Collapse
|
22
|
Harris A. Diagnosis and management of children with primary ciliary dyskinesia. Nurs Child Young People 2017; 29:38-47. [PMID: 29115761 DOI: 10.7748/ncyp.2017.e936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetic disorder of the motile cilia characterised by chronic lung disease, nasal and sinus disease, chronic ear infections with glue ear leading to possible hearing impairment, and subfertility. Half of patients have organ laterality defects. Despite symptoms being present from birth, PCD remains underdiagnosed. Early diagnosis and symptom management may reduce morbidity, improve quality of life and ensure children are adequately supported to meet their full potential. This article seeks to raise awareness of PCD in children's nurses who are well placed to identify children for referral to the national PCD diagnostic service. It examines the clinical characteristics of the disease along with the complexities and limitations of diagnostic testing. In addition, it explores the management of children with PCD within the national PCD management service for children.
Collapse
Affiliation(s)
- Amanda Harris
- University Hospital Southampton NHS Foundation Trust, Hampshire, England
| |
Collapse
|
23
|
Reula A, Lucas JS, Moreno-Galdó A, Romero T, Milara X, Carda C, Mata-Roig M, Escribano A, Dasi F, Armengot-Carceller M. New insights in primary ciliary dyskinesia. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1324780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ana Reula
- Universitat de Valencia, Valencia, Spain
- UCIM Department, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - JS Lucas
- Primary Ciliary Dyskinesia Centre, University of Southampton Faculty of Medicine, Southampton, UK
| | - Antonio Moreno-Galdó
- Pediatrics Pneumology and Cystic Fibrosis Unit, Hospital Vall d’Hebron, Barcelona, Spain
- Department of Pediatrics, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa Romero
- Pediatrics Pneumology and Cystic Fibrosis Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Xavier Milara
- Department of Pharmacy, Universitat Jaume I, Castello de la Plana, Spain
| | | | | | - Amparo Escribano
- Universitat de Valencia, Valencia, Spain
- Pediatrics Pneumology and Cystic Fibrosis Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francisco Dasi
- Universitat de Valencia, Valencia, Spain
- UCIM Department, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Miguel Armengot-Carceller
- Universitat de Valencia, Valencia, Spain
- Oto-Rino- Laryngology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| |
Collapse
|
24
|
Abstract
Systemic and odontogenic etiologies of chronic rhinosinusitis, although rare, are an integral consideration in the comprehensive management of patients with sinonasal disease. Proper knowledge and timely recognition of each disease process, with referrals to appropriate consultants, will facilitate treatment, because many of these conditions require both local and systemic therapy. In some instances, medical therapy plays a pivotal role, with surgery being a supplemental treatment technique. We review the most commonly encountered systemic etiologies of chronic rhinosinusitis and odontogenic sinusitis, including clinical presentation, diagnosis, management, and treatment outcomes.
Collapse
Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, 62-132 CHS, Los Angeles, CA 90095, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA) Medical Center, 10833 Le Conte Avenue, 62-132 CHS, Los Angeles, CA 90095, USA.
| |
Collapse
|
25
|
Prevalence of primary ciliary dyskinesia in consecutive referrals of suspect cases and the transmission electron microscopy detection rate: a systematic review and meta-analysis. Pediatr Res 2017; 81:398-405. [PMID: 27935903 DOI: 10.1038/pr.2016.263] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/09/2016] [Indexed: 11/08/2022]
Abstract
Diagnostic testing for primary ciliary dyskinesia (PCD) usually includes transmission electron microscopy (TEM), nasal nitric oxide, high-speed video microscopy, and genetics. Diagnostic performance of each test should be assessed toward the development of PCD diagnostic algorithms. We systematically reviewed the literature and quantified PCD prevalence among referrals and TEM detection rate in confirmed PCD patients. Major electronic databases were searched until December 2015 using appropriate terms. Included studies described cohorts of consecutive PCD referrals in which PCD was confirmed by at least TEM and one additional test, in order to compare the index test performance with other test(s). Meta-analyses of pooled PCD prevalence and TEM detection rate across studies were performed. PCD prevalence among referrals was 32% (95% CI: 25-39%, I2 = 92%). TEM detection rate among PCD patients was 83% (95% CI: 75-90%, I2 = 90%). Exclusion of studies reporting isolated inner dynein arm defects as PCD, reduced TEM detection rate and explained an important fraction of observed heterogeneity (74%, 95% CI: 66-83%, I2 = 66%). Approximately, one third of referrals, are diagnosed with PCD. Among PCD patients, a significant percentage, at least as high as 26%, is missed by TEM, a limitation that should be accounted toward the development of an efficacious PCD diagnostic algorithm.
Collapse
|
26
|
Rumman N, Jackson C, Collins S, Goggin P, Coles J, Lucas JS. Diagnosis of primary ciliary dyskinesia: potential options for resource-limited countries. Eur Respir Rev 2017; 26:26/143/160058. [DOI: 10.1183/16000617.0058-2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022] Open
Abstract
Primary ciliary dyskinesia is a genetic disease of ciliary function leading to chronic upper and lower respiratory tract symptoms. The diagnosis is frequently overlooked because the symptoms are nonspecific and the knowledge about the disease in the primary care setting is poor. Additionally, none of the available tests is accurate enough to be used in isolation. These tests are expensive, and need sophisticated equipment and expertise to analyse and interpret results; diagnosis is therefore only available at highly specialised centres. The diagnosis is particularly challenging in countries with limited resources due to the lack of such costly equipment and expertise.In this review, we discuss the importance of early and accurate diagnosis especially for countries where the disease is clinically prevalent but diagnostic tests are lacking. We review the diagnostic tests available in specialised centres (nasal nitric oxide, high-speed video microscopy, transmission electron microscopy, immunofluorescence and genetics). We then consider modifications that might be considered in less well-resourced countries whilst maintaining acceptable accuracy.
Collapse
|
27
|
Lucas JS, Barbato A, Collins SA, Goutaki M, Behan L, Caudri D, Dell S, Eber E, Escudier E, Hirst RA, Hogg C, Jorissen M, Latzin P, Legendre M, Leigh MW, Midulla F, Nielsen KG, Omran H, Papon JF, Pohunek P, Redfern B, Rigau D, Rindlisbacher B, Santamaria F, Shoemark A, Snijders D, Tonia T, Titieni A, Walker WT, Werner C, Bush A, Kuehni CE. European Respiratory Society guidelines for the diagnosis of primary ciliary dyskinesia. Eur Respir J 2017; 49:13993003.01090-2016. [PMID: 27836958 DOI: 10.1183/13993003.01090-2016] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/25/2016] [Indexed: 01/30/2023]
Abstract
The diagnosis of primary ciliary dyskinesia is often confirmed with standard, albeit complex and expensive, tests. In many cases, however, the diagnosis remains difficult despite the array of sophisticated diagnostic tests. There is no "gold standard" reference test. Hence, a Task Force supported by the European Respiratory Society has developed this guideline to provide evidence-based recommendations on diagnostic testing, especially in light of new developments in such tests, and the need for robust diagnoses of patients who might enter randomised controlled trials of treatments. The guideline is based on pre-defined questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. It focuses on clinical presentation, nasal nitric oxide, analysis of ciliary beat frequency and pattern by high-speed video-microscopy analysis, transmission electron microscopy, genotyping and immunofluorescence. It then used a modified Delphi survey to develop an algorithm for the use of diagnostic tests to definitively confirm and exclude the diagnosis of primary ciliary dyskinesia; and to provide advice when the diagnosis was not conclusive. Finally, this guideline proposes a set of quality criteria for future research on the validity of diagnostic methods for primary ciliary dyskinesia.
Collapse
Affiliation(s)
- Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Angelo Barbato
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padova, Italy
| | - Samuel A Collins
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Dept of Paediatrics, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Daan Caudri
- Telethon Kids Institute, The University of Western Australia, Subiaco, Australia.,Dept of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam, The Netherlands
| | - Sharon Dell
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Dept of Pediatrics and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Estelle Escudier
- Service de Génétique et Embryologie Médicales, Centre de Référence des Maladies Respiratoires Rares, Hôpital Armand Trousseau, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm UMR_S933, Sorbonne Universités (UPMC Univ Paris 06), Paris, France
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Claire Hogg
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Mark Jorissen
- ENT Dept, University Hospitals Leuven, Leuven, Belgium
| | - Philipp Latzin
- Dept of Paediatrics, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Marie Legendre
- Service de Génétique et Embryologie Médicales, Centre de Référence des Maladies Respiratoires Rares, Hôpital Armand Trousseau, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm UMR_S933, Sorbonne Universités (UPMC Univ Paris 06), Paris, France
| | - Margaret W Leigh
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fabio Midulla
- Paediatric Dept, Sapienza University of Rome, Rome, Italy
| | - Kim G Nielsen
- Danish PCD & chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Heymut Omran
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Jean-Francois Papon
- AP-HP, Hôpital Kremlin-Bicetre, service d'ORL et de chirurgie cervico-faciale, Le Kremlin-Bicetre, France.,Faculté de Médecine, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Petr Pohunek
- Paediatric Dept, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | | | - Francesca Santamaria
- Pediatric Pulmonology, Dept of Translational Medical Sciences, Federico II University, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Amelia Shoemark
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Deborah Snijders
- Primary Ciliary Dyskinesia Centre, Dept of Woman and Child Health (SDB), University of Padova, Padova, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Titieni
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton Faculty of Medicine, Academic Unit of Clinical and Experimental Medicine, Southampton, UK
| | - Claudius Werner
- Dept of Pediatrics, University Hospital Muenster, Münster Germany
| | - Andrew Bush
- Depts of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
28
|
Abitbul R, Amirav I, Blau H, Alkrinawi S, Aviram M, Shoseyov D, Bentur L, Avital A, Springer C, Lavie M, Prais D, Dabbah H, Elias N, Elizur A, Goldberg S, Hevroni A, Kerem E, Luder A, Roth Y, Cohen-Cymberknoh M, Ben Ami M, Mandelberg A, Livnat G, Picard E, Rivlin J, Rotschild M, Soferman R, Loges NT, Olbrich H, Werner C, Wolter A, Herting M, Wallmeier J, Raidt J, Omran H, Mussaffi H. Primary ciliary dyskinesia in Israel: Prevalence, clinical features, current diagnosis and management practices. Respir Med 2016; 119:41-47. [DOI: 10.1016/j.rmed.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/05/2016] [Accepted: 08/21/2016] [Indexed: 11/29/2022]
|
29
|
Kempeneers C, Seaton C, Chilvers MA. Variation of Ciliary Beat Pattern in Three Different Beating Planes in Healthy Subjects. Chest 2016; 151:993-1001. [PMID: 27693596 DOI: 10.1016/j.chest.2016.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Digital high-speed video microscopy (DHSV) allows analysis of ciliary beat frequency (CBF) and ciliary beat pattern (CBP) of respiratory cilia in three planes. Normal reference data use a sideways edge to evaluate ciliary dyskinesia and calculate CBF using the time needed for a cilium to complete 10 beat cycles. Variability in CBF within the respiratory epithelium has been described, but data concerning variation of CBP is limited in healthy epithelium. This study aimed to document variability of CBP in normal samples, to compare ciliary function in three profiles, and to compare CBF calculated over five or 10 beat cycles. METHODS Nasal brushing samples from 13 healthy subjects were recorded using DHSV in three profiles. CBP and CBF over a 10-beat cycle were evaluated in all profiles, and CBF was reevaluated over five-beat cycles in the sideways edges. RESULTS A uniform CBP was seen in 82.1% of edges. In the sideways profile, uniformity within the edge was lower (uniform normal CBP, 69.1% [sideways profile]; 97.1% [toward the observer], 92.0% [from above]), and dyskinesia was higher. Interobserver agreement for dyskinesia was poor. CBF was not different between profiles (P = .8097) or between 10 and five beat cycles (P = .1126). CONCLUSIONS Our study demonstrates a lack of uniformity and consistency in manual CBP analysis of samples from healthy subjects, emphasizing the risk of automated CBP analysis in limited regions of interest and of single and limited manual CBP analysis. The toward the observer and from above profiles may be used to calculate CBF but may be less sensitive for evaluation of ciliary dyskinesia and CBP. CBF can be measured reliably by evaluation of only five-beat cycles.
Collapse
Affiliation(s)
- Celine Kempeneers
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Claire Seaton
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Mark A Chilvers
- Division of Respirology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada.
| |
Collapse
|
30
|
Boaretto F, Snijders D, Salvoro C, Spalletta A, Mostacciuolo ML, Collura M, Cazzato S, Girosi D, Silvestri M, Rossi GA, Barbato A, Vazza G. Diagnosis of Primary Ciliary Dyskinesia by a Targeted Next-Generation Sequencing Panel: Molecular and Clinical Findings in Italian Patients. J Mol Diagn 2016; 18:912-922. [PMID: 27637300 DOI: 10.1016/j.jmoldx.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/07/2016] [Accepted: 07/15/2016] [Indexed: 11/26/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder that alters mucociliary clearance, with consequent chronic disease of upper and lower airways. Diagnosis of PCD is challenging, and genetic testing is hampered by the high heterogeneity of the disease, because autosomal recessive causative mutations were found in 34 different genes. In this study, we clinically and molecularly characterized a cohort of 51 Italian patients with clinical signs of PCD. A custom next-generation sequencing panel that enables the affordable and simultaneous screening of 24 PCD genes was developed for genetic analysis. After variant filtering and prioritization, the molecular diagnosis of PCD was achieved in 43% of the patients. Overall, 5 homozygous and 27 compound heterozygous mutations, 21 of which were never reported before, were identified in 11 PCD genes. The DNAH5 and DNAH11 genes were the most common cause of PCD in Italy, but some population specificities were identified. In addition, the number of unsolved cases and the identification of only a single mutation in six patients suggest further genetic heterogeneity and invoke the need of novel strategies to detect unconventional pathogenic DNA variants. Finally, despite the availability of mutation databases and in silico prediction tools helping the interpretation of variants in next-generation sequencing screenings, a comprehensive segregation analysis is required to establish the in trans inheritance and support the pathogenic role of mutations.
Collapse
Affiliation(s)
| | - Deborah Snijders
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - Mirella Collura
- Cystic Fibrosis and Respiratory Pediatric Center, Arnas Children Hospital, Palermo, Italy
| | - Salvatore Cazzato
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Donatella Girosi
- Pediatric Pulmonology Unit, Istitute Giannina Gaslini, Genova, Italy
| | - Michela Silvestri
- Pediatric Pulmonology Unit, Istitute Giannina Gaslini, Genova, Italy
| | | | - Angelo Barbato
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giovanni Vazza
- Department of Biology, University of Padova, Padova, Italy.
| |
Collapse
|
31
|
Amirav I, Roduta Roberts M, Mussaffi H, Mandelberg A, Roth Y, Abitbul R, Luder A, Blau H, Alkrinawi S, Aviram M, Ben-Ami M, Rotschild M, Bentur L, Shoseyov D, Cohen-Cymberknoh M, Kerem E, Avital A, Springer C, Hevroni A, Dabbah H, Elizur A, Picard E, Goldberg S, Rivlin J, Livnat G, Lavie M, Alias N, Soferman R, Olbrich H, Raidt J, Wallmeier J, Werner C, Loges NT, Omran H. Collecting clinical data in primary ciliary dyskinesia- challenges and opportunities. F1000Res 2016; 5:2031. [PMID: 27781089 PMCID: PMC5022703 DOI: 10.12688/f1000research.9323.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/20/2022] Open
Abstract
Rationale: Primary ciliary dyskinesia (PCD) is under diagnosed and underestimated. Most clinical research has used some form of questionnaires to capture data but none has been critically evaluated particularly with respect to its end-user feasibility and utility. Objective: To critically appraise a clinical data collection questionnaire for PCD used in a large national PCD consortium in order to apply conclusions in future PCD research. Methods: We describe the development, validation and revision process of a clinical questionnaire for PCD and its evaluation during a national clinical PCD study with respect to data collection and analysis, initial completion rates and user feedback. Results: 14 centers participating in the consortium successfully completed the revised version of the questionnaire for 173 patients with various completion rates for various items. While content and internal consistency analysis demonstrated validity, there were methodological deficiencies impacting completion rates and end-user utility. These deficiencies were addressed resulting in a more valid questionnaire. Conclusions: Our experience may be useful for future clinical research in PCD. Based on the feedback collected on the questionnaire through analysis of completion rates, judgmental analysis of the content, and feedback from experts and end users, we suggest a practicable framework for development of similar tools for various future PCD research.
Collapse
Affiliation(s)
- Israel Amirav
- Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Huda Mussaffi
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | - Yehudah Roth
- The Edith Wolfson Medical Center, Tel Aviv University, Holon, Israel
| | - Revital Abitbul
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Anthony Luder
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hannah Blau
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel
| | | | | | - Marta Ben-Ami
- Department of Pediatrics, Ziv Medical Center, Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | | | - David Shoseyov
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | | | - Eitan Kerem
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avraham Avital
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Chaim Springer
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Avigdor Hevroni
- Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - Husein Dabbah
- Galilee Medical Center, Naharia, Bar Ilan Faculty of Medicine, Safed, Israel
| | | | - Elie Picard
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | | | | | - Moran Lavie
- Sheba Medical Center , Tel Aviv University, Tel Aviv, Israel
| | | | | | - Heike Olbrich
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Claudius Werner
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Niki T Loges
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| |
Collapse
|
32
|
Suarez-Cuartin G, Chalmers JD, Sibila O. Diagnostic challenges of bronchiectasis. Respir Med 2016; 116:70-7. [DOI: 10.1016/j.rmed.2016.05.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/18/2016] [Accepted: 05/16/2016] [Indexed: 02/07/2023]
|
33
|
Quinn SP, Zahid MJ, Durkin JR, Francis RJ, Lo CW, Chennubhotla SC. Automated identification of abnormal respiratory ciliary motion in nasal biopsies. Sci Transl Med 2016; 7:299ra124. [PMID: 26246169 DOI: 10.1126/scitranslmed.aaa1233] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Motile cilia lining the nasal and bronchial passages beat synchronously to clear mucus and foreign matter from the respiratory tract. This mucociliary defense mechanism is essential for pulmonary health, because respiratory ciliary motion defects, such as those in patients with primary ciliary dyskinesia (PCD) or congenital heart disease, can cause severe sinopulmonary disease necessitating organ transplant. The visual examination of nasal or bronchial biopsies is critical for the diagnosis of ciliary motion defects, but these analyses are highly subjective and error-prone. Although ciliary beat frequency can be computed, this metric cannot sensitively characterize ciliary motion defects. Furthermore, PCD can present without any ultrastructural defects, limiting the use of other detection methods, such as electron microscopy. Therefore, an unbiased, computational method for analyzing ciliary motion is clinically compelling. We present a computational pipeline using algorithms from computer vision and machine learning to decompose ciliary motion into quantitative elemental components. Using this framework, we constructed digital signatures for ciliary motion recognition and quantified specific properties of the ciliary motion that allowed high-throughput classification of ciliary motion as normal or abnormal. We achieved >90% classification accuracy in two independent data cohorts composed of patients with congenital heart disease, PCD, or heterotaxy, as well as healthy controls. Clinicians without specialized knowledge in machine learning or computer vision can operate this pipeline as a "black box" toolkit to evaluate ciliary motion.
Collapse
Affiliation(s)
- Shannon P Quinn
- Joint Carnegie Mellon-University of Pittsburgh Ph.D. Program in Computational Biology, Department of Computation and Systems Biology, University of Pittsburgh, Pittsburgh, PA 15260, USA. Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
| | - Maliha J Zahid
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA
| | - John R Durkin
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Richard J Francis
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15201, USA.
| | - S Chakra Chennubhotla
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA.
| |
Collapse
|
34
|
Morgan LC, Birman CS. The impact of Primary Ciliary Dyskinesia on the upper respiratory tract. Paediatr Respir Rev 2016; 18:33-8. [PMID: 26898410 DOI: 10.1016/j.prrv.2015.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Primary Ciliary Dyskinesia (PCD) is an autosomal recessive genetic condition affecting the function of motile cilia. The upper respiratory tract is lined with ciliated epithelium and hence a hallmark of PCD is the development, from the neonatal period onwards, of persisting secretion retention and suppurative infection in the middle ear, nose and facial sinuses [1]. This review aims to remind the clinician involved in the care of a patient with PCD of the complexities of making the diagnosis of chronic rhinosinusitis (CRS) and chronic otitis media with effusion (ChOME), the morbidity associated with CRS and ChOME and of current evidence of best practice for the management of these conditions.
Collapse
Affiliation(s)
- Lucy C Morgan
- Sydney Medical School, University of Sydney, NSW; Department of Thoracic Medicine, Concord Hospital, Sydney, NSW; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW.
| | - Catherine S Birman
- Sydney Medical School, University of Sydney, NSW; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW; Department of ENT Surgery, The Children's Hospital at Westmead, Sydney, NSW
| |
Collapse
|
35
|
Lucas JS, Paff T, Goggin P, Haarman E. Diagnostic Methods in Primary Ciliary Dyskinesia. Paediatr Respir Rev 2016; 18:8-17. [PMID: 26362507 DOI: 10.1016/j.prrv.2015.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
Diagnosing primary ciliary dyskinesia is difficult. With no reference standard, a combination of tests is needed; most tests require expensive equipment and specialist scientists. We review the advances in diagnostic testing over the past hundred years, with emphasis on recent advances. We particularly focus on use of high-speed video analysis, transmission electron microscopy, nasal nitric oxide and genetic testing. We discuss the international efforts that are in place to advance the evidence base for diagnostic tests.
Collapse
Affiliation(s)
- Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Tamara Paff
- Department of Pediatric Pulmonology, VU University Medical Center, Amsterdam, the Netherlands; Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Patricia Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Eric Haarman
- Department of Pediatric Pulmonology, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
36
|
Shapiro AJ, Zariwala MA, Ferkol T, Davis SD, Sagel SD, Dell SD, Rosenfeld M, Olivier KN, Milla C, Daniel SJ, Kimple AJ, Manion M, Knowles MR, Leigh MW. Diagnosis, monitoring, and treatment of primary ciliary dyskinesia: PCD foundation consensus recommendations based on state of the art review. Pediatr Pulmonol 2016; 51:115-32. [PMID: 26418604 PMCID: PMC4912005 DOI: 10.1002/ppul.23304] [Citation(s) in RCA: 240] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/30/2015] [Accepted: 08/21/2015] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a genetically heterogeneous, rare lung disease resulting in chronic oto-sino-pulmonary disease in both children and adults. Many physicians incorrectly diagnose PCD or eliminate PCD from their differential diagnosis due to inexperience with diagnostic testing methods. Thus far, all therapies used for PCD are unproven through large clinical trials. This review article outlines consensus recommendations from PCD physicians in North America who have been engaged in a PCD centered research consortium for the last 10 years. These recommendations have been adopted by the governing board of the PCD Foundation to provide guidance for PCD clinical centers for diagnostic testing, monitoring, and appropriate short and long-term therapeutics in PCD patients.
Collapse
Affiliation(s)
- Adam J Shapiro
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Quebec, Canada
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Marsico Lung Institute, Chapel Hill, North Carolina
| | - Thomas Ferkol
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie D Davis
- Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Sharon D Dell
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Margaret Rosenfeld
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | | | - Carlos Milla
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sam J Daniel
- Department of Otolaryngology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Michael R Knowles
- Department of Medicine, University of North Carolina, Marsico Lung Institute, Chapel Hill, North Carolina
| | - Margaret W Leigh
- Department of Pediatrics, University of North Carolina, Marsico Lung Institute, Chapel Hill, North Carolina
| |
Collapse
|
37
|
Olm MAK, Caldini EG, Mauad T. Diagnosis of primary ciliary dyskinesia. J Bras Pneumol 2016; 41:251-63. [PMID: 26176524 PMCID: PMC4541762 DOI: 10.1590/s1806-37132015000004447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a genetic disorder of ciliary structure or function. It results in mucus accumulation and bacterial colonization of the respiratory tract which leads to chronic upper and lower airway infections, organ laterality defects, and fertility problems. We review the respiratory signs and symptoms of PCD, as well as the screening tests for and diagnostic investigation of the disease, together with details related to ciliary function, ciliary ultrastructure, and genetic studies. In addition, we describe the difficulties in diagnosing PCD by means of transmission electron microscopy, as well as describing patient follow-up procedures.
Collapse
Affiliation(s)
- Mary Anne Kowal Olm
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elia Garcia Caldini
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
38
|
Kouis P, Papatheodorou SI, Yiallouros PK. Diagnostic accuracy of nasal nitric oxide for establishing diagnosis of primary ciliary dyskinesia: a meta-analysis. BMC Pulm Med 2015; 15:153. [PMID: 26634346 PMCID: PMC4669667 DOI: 10.1186/s12890-015-0147-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, diagnosis of Primary Ciliary Dyskinesia (PCD) remains difficult and challenging. We systematically evaluated the diagnostic performance of nasal Nitric Oxide (nNO) measurement for the detection of PCD, using either velum-closure (VC) or non-velum-closure (non-VC) techniques. METHODS All major electronic databases were searched from inception until March 2015 using appropriate terms. The sensitivity and specificity of nNO measurement was calculated in PCD patients diagnosed by transmission electron microscopy, high speed video-microscopy or genetic testing. Summary receiver operating characteristic (HSROC) curves were drawn using the parameters of the fitted models. RESULTS Twelve studies provided data for 13 different populations, including nine case-control (n = 793) and four prospective cohorts (n = 392). The overall sensitivity of nNO measured by VC techniques was 0.95 (95 % CI 0.91-0.97), while specificity was 0.94 (95 % CI 0.88-0.97). The positive likelihood ratio (LR+) of the test was 15.8 (95 % CI 8.1-30.6), whereas the negative likelihood ratio (LR-) was 0.06 (95 % CI 0.04-0.09). For non-VC techniques, the overall sensitivity of nNO measurement was 0.93 (95 % CI 0.89-0.96) whereas specificity was 0.95 (95 % CI 0.82-0.99). The LR+ of the test was 18.5 (95 % CI 4.6-73.8) whereas the LR- was 0.07 (95 % CI 0.04-0.12). CONCLUSIONS Diagnostic accuracy of nNO measurement both with VC and non-VC maneuvers is high and can be effectively employed in the clinical setting to detect PCD even in young children, thus potentiating early diagnosis. Measurement of nNO merits to be part of a revised diagnostic algorithm with the most efficacious combination of tests to achieve PCD diagnosis.
Collapse
Affiliation(s)
- Panayiotis Kouis
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, 95 Irenes Street, 3041, Limassol, Cyprus.
| | - Stefania I Papatheodorou
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, 95 Irenes Street, 3041, Limassol, Cyprus.
| | - Panayiotis K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, 95 Irenes Street, 3041, Limassol, Cyprus. .,Department of Pediatrics, Hospital "Archbishop Makarios III", Nicosia, Cyprus.
| |
Collapse
|
39
|
Jackson CL, Behan L, Collins SA, Goggin PM, Adam EC, Coles JL, Evans HJ, Harris A, Lackie P, Packham S, Page A, Thompson J, Walker WT, Kuehni C, Lucas JS. Accuracy of diagnostic testing in primary ciliary dyskinesia. Eur Respir J 2015; 47:837-48. [PMID: 26647444 PMCID: PMC4771621 DOI: 10.1183/13993003.00749-2015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/15/2015] [Indexed: 11/26/2022]
Abstract
Diagnosis of primary ciliary dyskinesia (PCD) lacks a “gold standard” test and is therefore based on combinations of tests including nasal nitric oxide (nNO), high-speed video microscopy analysis (HSVMA), genotyping and transmission electron microscopy (TEM). There are few published data on the accuracy of this approach. Using prospectively collected data from 654 consecutive patients referred for PCD diagnostics we calculated sensitivity and specificity for individual and combination testing strategies. Not all patients underwent all tests. HSVMA had excellent sensitivity and specificity (100% and 93%, respectively). TEM was 100% specific, but 21% of PCD patients had normal ultrastructure. nNO (30 nL·min−1 cut-off) had good sensitivity and specificity (91% and 96%, respectively). Simultaneous testing using HSVMA and TEM was 100% sensitive and 92% specific. In conclusion, combination testing was found to be a highly accurate approach for diagnosing PCD. HSVMA alone has excellent accuracy, but requires significant expertise, and repeated sampling or cell culture is often needed. TEM alone is specific but misses 21% of cases. nNO (≤30 nL·min−1) contributes well to the diagnostic process. In isolation nNO screening at this cut-off would miss ∼10% of cases, but in combination with HSVMA could reduce unnecessary further testing. Standardisation of testing between centres is a future priority. Combination testing in PCD diagnosis remains the most accurate approach, but standardisation is neededhttp://ow.ly/TLEDu
Collapse
Affiliation(s)
- Claire L Jackson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK Both authors contributed equally
| | - Laura Behan
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK Department of Applied Psychology, University College Cork, Cork, Ireland Both authors contributed equally
| | - Samuel A Collins
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patricia M Goggin
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Biomedical Imaging Unit, University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth C Adam
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Janice L Coles
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Hazel J Evans
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter Lackie
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK Biomedical Imaging Unit, University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Samantha Packham
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anton Page
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Biomedical Imaging Unit, University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Woolf T Walker
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Claudia Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jane S Lucas
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
40
|
Honoré I, Burgel PR. Primary ciliary dyskinesia in adults. Rev Mal Respir 2015; 33:165-89. [PMID: 26654126 DOI: 10.1016/j.rmr.2015.10.743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/08/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Primary ciliary dyskinesia is an autosomal recessive genetic disorder leading to structural and/or functional abnormalities of motor cilia. Impaired mucociliary clearance is responsible for the development of a multi-organ disease, which particularly affects the upper and lower airways. STATE OF THE ART In adults, primary ciliary dyskinesia is mainly characterized by bronchiectasis and chronic ear and sinus disorders. Situs inversus is found in half of patients and fertility disorders are commonly associated. Diagnosis is based on specialized tests: reduced level of nasal nitric oxide concentrations is suggestive of primary ciliary dyskinesia, but only a nasal or bronchial biopsy/brushing with analysis of beat pattern by videomicroscopy and/or analysis of cilia morphology by electronic microscopy can confirm the diagnosis. However, the diagnosis is difficult to achieve due to the limited access to these specialized tests and to difficulties in interpreting them. Genetic tests are under development and may provide new diagnostic tools. Treatment is symptomatic, based on airway clearance techniques (e.g., physiotherapy) and systemic and/or inhaled antibiotics. Prognosis is related to the severity of the respiratory impairment, which can be moderate or severe. PERSPECTIVES AND CONCLUSIONS Diagnosis and management of primary ciliary dyskinesia remain poorly defined and should be supported by specialized centers to standardize the diagnosis, improve the treatment and promote research.
Collapse
Affiliation(s)
- I Honoré
- Department of respiratory medicine, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - P-R Burgel
- Department of respiratory medicine, Cochin hospital, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Paris Descartes university, Sorbonne Paris Cité, 75005 Paris, France.
| |
Collapse
|
41
|
Funfak A, Fisch C, Abdel Motaal HT, Diener J, Combettes L, Baroud CN, Dupuis-Williams P. Paramecium swimming and ciliary beating patterns: a study on four RNA interference mutations. Integr Biol (Camb) 2015; 7:90-100. [PMID: 25383612 DOI: 10.1039/c4ib00181h] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Paramecium cells swim and feed by beating their thousands of cilia in coordinated patterns. The organization of these patterns and its relationship with cell motility has been the subject of a large body of work, particularly as a model for ciliary beating in human organs where similar organization is seen. However the rapid motion of the cells makes quantitative measurements very challenging. Here we provide detailed measurements of the swimming of Paramecium cells from high-speed video at high magnification, as they move in microfluidic channels. An image analysis protocol allows us to decouple the cell movement from the motion of the cilia, thus allowing us to measure the ciliary beat frequency (CBF) and the spatio-temporal organization into metachronal waves along the cell periphery. Two distinct values of the CBF appear at different regions of the cell: most of the cilia beat in the range of 15 to 45 Hz, while the cilia in the peristomal region beat at almost double the frequency. The body and peristomal CBF display a nearly linear relation with the swimming velocity. Moreover the measurements do not display a measurable correlation between the swimming velocity and the metachronal wave velocity on the cell periphery. These measurements are repeated for four RNAi silenced mutants, where proteins specific to the cilia or to their connection to the cell base are depleted. We find that the mutants whose ciliary structure is affected display similar swimming to the control cells albeit with a reduced efficiency, while the mutations that affect the cilia's anchoring to the cell lead to strongly reduced ability to swim. This reduction in motility can be related to a loss of coordination between the ciliary beating in different parts of the cell.
Collapse
Affiliation(s)
- Anette Funfak
- Department of Mechanics, LadHyX, Ecole Polytechnique-CNRS, F-91128 Palaiseau, France.
| | | | | | | | | | | | | |
Collapse
|
42
|
Cao Y, Shao C, Song Y, Bai C, He L. Clinical analysis of patients with primary ciliary dyskinesia in mainland China. CLINICAL RESPIRATORY JOURNAL 2015; 10:765-771. [PMID: 25764361 DOI: 10.1111/crj.12284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 02/04/2015] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Primary ciliary dyskinesia (PCD) is a rare, genetic disorder featured with dysfunctional motility of cilia. Clinical presentations of PCD include situs inversus, repeated respiratory tract infections, otitis media, sinusitis and infertility. This study aims to provide clinical strategies on diagnosis and treatment of PCD. METHODS Clinical data of seven patients diagnosed as PCD in Zhongshan Hospital, Fudan University were analyzed. We also extracted data from other cases in mainland China from the China Academic Journals Full-Text Database by the end of 2012. A total of 127 cases of PCD were summarized and analyzed in this study. RESULTS Seven patients in Zhongshan Hospital, Fudan University were finally confirmed to have PCD. All of them had clinical history of recurrent respiratory infection. Imaging analysis showed varying degrees of bronchiectasis. Pulmonary function tests in four patients showed combined obstructive and restrictive patterns. Three cases were confirmed to have PCD by electron microscopy. We then further extracted information from literature for those 127 PCD patients in mainland China. All of them had chronic respiratory infection. Seven cases were complicated with recurrent otitis media and 15 cases were complicated with infertility. A total of 119 patients were diagnosed with situs inversus totalis (94%). Among those 127 patients, only 9 patients' diagnosis was confirmed by electron microscopy. Four patients received sinus resection, and one patient received pulmonary lobectomy due to recurrent hemoptysis. One patient died of massive hemoptysis. CONCLUSIONS Being a rare disease and easily confused with uncomplicated bronchiectasis, PCD diagnosis warrants particular attention. Recurrent respiratory infection, especially situs inversus could be the most important indicator of this disease.
Collapse
Affiliation(s)
- Yueqin Cao
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Pulmonary Medicine, The Forth People's Hospital of Taizhou, Taizhou, Jiangsu Province, China
| | - Changzhou Shao
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yuanlin Song
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunxue Bai
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lixian He
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
43
|
Abstract
Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder of cilia structure, function, and biogenesis leading to chronic infections of the respiratory tract, fertility problems, and disorders of organ laterality. The diagnosis can be challenging, using traditional tools such as characteristic clinical features, ciliary function, and ultrastructural defects and newer screening tools such as nasal nitric oxide levels and genetic testing add to the diagnostic algorithm. There are 32 known PCD-causing genes, and in the future, comprehensive genetic testing may screen young infants before developing symptoms, thus improving survival. Therapies include surveillance of pulmonary function and microbiology, in addition to airway clearance, antibiotics, and early referral to bronchiectasis centers. As with cystic fibrosis (CF), standardized care at specialized centers using a multidisciplinary approach likely improves outcomes. In conjunction with the CF foundation, the PCD foundation, with experienced investigators and clinicians, is developing a network of PCD clinical centers to coordinate the effort in North America and Europe. As the network grows, clinical care and knowledge will improve.
Collapse
Affiliation(s)
- Jason Lobo
- The Division of Pulmonary Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Maimoona A Zariwala
- The Division of Pulmonary Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Peadar G Noone
- The Division of Pulmonary Diseases, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
44
|
Praveen K, Davis EE, Katsanis N. Unique among ciliopathies: primary ciliary dyskinesia, a motile cilia disorder. F1000PRIME REPORTS 2015; 7:36. [PMID: 25926987 PMCID: PMC4371376 DOI: 10.12703/p7-36] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a ciliopathy, but represents the sole entity from this class of disorders that results from the dysfunction of motile cilia. Characterized by respiratory problems appearing in childhood, infertility, and situs defects in ~50% of individuals, PCD has an estimated prevalence of approximately 1 in 10,000 live births. The diagnosis of PCD can be prolonged due to a lack of disease awareness, coupled with the fact that symptoms can be confused with other more common genetic disorders, such as cystic fibrosis, or environmental insults that result in frequent respiratory infections. A primarily autosomal recessive disorder, PCD is genetically heterogeneous with >30 causal genes identified, posing significant challenges to genetic diagnosis. Here, we provide an overview of PCD as a disorder underscored by impaired ciliary motility; we discuss the recent advances towards uncovering the genetic basis of PCD; we discuss the molecular knowledge gained from PCD gene discovery, which has improved our understanding of motile ciliary assembly; and we speculate on how accelerated diagnosis, together with detailed phenotypic data, will shape the genetic and functional architecture of this disorder.
Collapse
|
45
|
Amirav I, Mussaffi H, Roth Y, Schmidts M, Omran H, Werner C. A reach-out system for video microscopy analysis of ciliary motions aiding PCD diagnosis. BMC Res Notes 2015; 8:71. [PMID: 25869032 PMCID: PMC4363456 DOI: 10.1186/s13104-015-0999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS High-speed Video-Microscopy Analysis (HVMA) is now being used to aid diagnosis of Primary Ciliary Dyskinesia (PCD). Only a few centers however, are equipped with the available resources and equipment to perform these tests. We describe our experience in HVMA reaching-out to many more peripheral and relatively remote areas. A portable computer with HVMA software, video camera and a microscope were used. Fourteen disperse pediatric centers were reached and a total of 203 subjects were tested within a relatively short time (Clinical Trial Registration: NCT 01070914 (registered February 6, 2010). RESULTS With an average time of 20 minutes per patient, the system enabled us to test approximately 10-15 subjects per day. A valid HVMA result was made in 148 subjects and helped in the diagnosis of PCD in many of the patients who were subsequently confirmed to have PCD by electron microscopy and/or immunofluoresence and/or genetics and/or nasal Nitric Oxide testing. The sensitivity of abnormal HVMA to accurately predict PCD was 90.2%. DISCUSSION AND CONCLUSION This is the first report of an out-reach system to record HVMA for improved diagnosis of PCD in remote regions that are not within reach of PCD centers and experts. It provides immediate preliminary results and instantaneous feedback to the physician, patient and his/her family members in these areas. Future studies to compare this system to conventional desk top systems are warranted. TRIAL REGISTRATION NCT 01070914 (registered February 6, 2010).
Collapse
|
46
|
Hosie P, Fitzgerald DA, Jaffe A, Birman CS, Morgan L. Primary ciliary dyskinesia: overlooked and undertreated in children. J Paediatr Child Health 2014; 50:952-8. [PMID: 24943508 DOI: 10.1111/jpc.12628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a multi-organ disorder associated with chronic oto-sino-pulmonary disease, neonatal respiratory distress, situs abnormalities and reduced fertility. Repeated respiratory tract infections leads to the almost universal development of bronchiectasis. These clinical manifestations are a consequence of poorly functioning motile cilia. However, confirming the diagnosis is quite difficult and is often delayed, so the true incidence of PCD may be significantly higher than current estimates. Nasal nitric oxide has been earmarked as a useful screening tool for identifying patients, but its use is limited in pre-school-aged children. Due to the rarity of PCD, the evidence base for management is somewhat limited, and treatment regimens are extrapolated from other suppurative lung disorders, like cystic fibrosis.
Collapse
Affiliation(s)
- Patrick Hosie
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, New South Wales, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney Medical School, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
47
|
Airway Ciliary Dysfunction and Sinopulmonary Symptoms in Patients with Congenital Heart Disease. Ann Am Thorac Soc 2014; 11:1426-32. [DOI: 10.1513/annalsats.201405-222oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
48
|
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetically heterogeneous disorder caused by the abnormal structure and/or function of motile cilia. The PCD diagnosis is challenging and requires a well-described clinical phenotype combined with the identification of abnormalities in ciliary ultrastructure and/or beating pattern as well as the recognition of genetic cause of the disease. Regarding the pace of identification of PCD-related genes, a rapid acceleration during the last 2-3 years is notable. This is the result of new technologies, such as whole-exome sequencing, that have been recently applied in genetic research. To date, PCD-causative mutations in 29 genes are known and the number of causative genes is bound to rise. Even though the genetic causes of approximately one-third of PCD cases still remain to be found, the current knowledge can already be used to create new, accurate genetic tests for PCD that can accelerate the correct diagnosis and reduce the proportion of unexplained cases. This review aims to present the latest data on the relations between ciliary structure aberrations and their genetic basis.
Collapse
Affiliation(s)
- Małgorzata Kurkowiak
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Ewa Ziętkiewicz
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
| | - Michał Witt
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland International Institute of Molecular and Cell Biology, Warsaw, Poland
| |
Collapse
|
49
|
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetically heterogeneous disorder caused by the abnormal structure and/or function of motile cilia. The PCD diagnosis is challenging and requires a well-described clinical phenotype combined with the identification of abnormalities in ciliary ultrastructure and/or beating pattern as well as the recognition of genetic cause of the disease. Regarding the pace of identification of PCD-related genes, a rapid acceleration during the last 2–3 years is notable. This is the result of new technologies, such as whole-exome sequencing, that have been recently applied in genetic research. To date, PCD-causative mutations in 29 genes are known and the number of causative genes is bound to rise. Even though the genetic causes of approximately one-third of PCD cases still remain to be found, the current knowledge can already be used to create new, accurate genetic tests for PCD that can accelerate the correct diagnosis and reduce the proportion of unexplained cases. This review aims to present the latest data on the relations between ciliary structure aberrations and their genetic basis.
Collapse
Affiliation(s)
- Małgorzata Kurkowiak
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Ewa Ziętkiewicz
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
| | - Michał Witt
- Department of Molecular and Clinical Genetics, Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland International Institute of Molecular and Cell Biology, Warsaw, Poland
| |
Collapse
|
50
|
Smith CM, Sandrini S, Datta S, Freestone P, Shafeeq S, Radhakrishnan P, Williams G, Glenn SM, Kuipers OP, Hirst RA, Easton AJ, Andrew PW, O'Callaghan C. Respiratory syncytial virus increases the virulence of Streptococcus pneumoniae by binding to penicillin binding protein 1a. A new paradigm in respiratory infection. Am J Respir Crit Care Med 2014; 190:196-207. [PMID: 24941423 DOI: 10.1164/rccm.201311-2110oc] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Respiratory syncytial virus (RSV) and Streptococcus pneumoniae are major respiratory pathogens. Coinfection with RSV and S. pneumoniae is associated with severe and often fatal pneumonia but the molecular basis for this remains unclear. OBJECTIVES To determine if interaction between RSV and pneumococci enhances pneumococcal virulence. METHODS We used confocal microscopy and Western blot to identify the receptors involved in direct binding of RSV and pneumococci, the effects of which were studied in both in vivo and in vitro models of infection. Human ciliated respiratory epithelial cell cultures were infected with RSV for 72 hours and then challenged with pneumococci. Pneumococci were collected after 2 hours exposure and changes in gene expression determined using quantitative real-time polymerase chain reaction. MEASUREMENTS AND MAIN RESULTS Following incubation with RSV or purified G protein, pneumococci demonstrated a significant increase in the inflammatory response and bacterial adherence to human ciliated epithelial cultures and markedly increased virulence in a pneumonia model in mice. This was associated with extensive changes in the pneumococcal transcriptome and significant up-regulation in the expression of key pneumococcal virulence genes, including the gene for the pneumococcal toxin, pneumolysin. We show that mechanistically this is caused by RSV G glycoprotein binding penicillin binding protein 1a. CONCLUSIONS The direct interaction between a respiratory virus protein and the pneumococcus resulting in increased bacterial virulence and worsening disease outcome is a new paradigm in respiratory infection.
Collapse
Affiliation(s)
- Claire M Smith
- 1 Respiratory, Critical Care and Anaesthesia, University College London, Institute of Child Health, Great Ormond Street Hospital, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|