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Despotes KA, Zariwala MA, Davis SD, Ferkol TW. Primary Ciliary Dyskinesia: A Clinical Review. Cells 2024; 13:974. [PMID: 38891105 PMCID: PMC11171568 DOI: 10.3390/cells13110974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous, motile ciliopathy, characterized by neonatal respiratory distress, recurrent upper and lower respiratory tract infections, subfertility, and laterality defects. Diagnosis relies on a combination of tests for confirmation, including nasal nitric oxide (nNO) measurements, high-speed videomicroscopy analysis (HSVMA), immunofluorescent staining, axonemal ultrastructure analysis via transmission electron microscopy (TEM), and genetic testing. Notably, there is no single gold standard confirmatory or exclusionary test. Currently, 54 causative genes involved in cilia assembly, structure, and function have been linked to PCD; this rare disease has a spectrum of clinical manifestations and emerging genotype-phenotype relationships. In this review, we provide an overview of the structure and function of motile cilia, the emerging genetics and pathophysiology of this rare disease, as well as clinical features associated with motile ciliopathies, novel diagnostic tools, and updates on genotype-phenotype relationships in PCD.
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Affiliation(s)
- Katherine A. Despotes
- Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maimoona A. Zariwala
- Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Marsico Lung Institute, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephanie D. Davis
- Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Thomas W. Ferkol
- Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Marsico Lung Institute, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Wee WB, Kinghorn B, Davis SD, Ferkol TW, Shapiro AJ. Primary Ciliary Dyskinesia. Pediatrics 2024; 153:e2023063064. [PMID: 38695103 PMCID: PMC11153322 DOI: 10.1542/peds.2023-063064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 06/02/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare, genetic disease characterized by dysfunctional motile cilia and abnormal mucociliary clearance, resulting in chronic sino-oto-pulmonary disease, neonatal respiratory distress, subfertility, and organ laterality defects. Over the past 2 decades, research and international collaborations have led to an improved understanding of disease prevalence, classic and variable phenotypes, novel diagnostics, genotype-phenotype correlations, long term morbidity, and innovative therapeutics. However, PCD is often underrecognized in clinical settings and the recent analyses of genetic databases suggest that only a fraction of these patients are being accurately diagnosed. Knowledge of significant advancements, from pathophysiology to the expanded range of clinical manifestations, will have important clinical impacts. These may include increasing disease recognition, improving diagnostic testing and management, and establishing an adequate pool of affected patients to enroll in upcoming clinical therapeutic trials. The objective of this state-of-the-art review is for readers to gain a greater understanding of the clinical spectrum of motile ciliopathies, cutting-edge diagnostic practices, emerging genotype-phenotype associations, and currently accepted management of people with PCD.
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Affiliation(s)
- Wallace B. Wee
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - BreAnna Kinghorn
- University of Washington, School of Medicine, Pediatrics, Seattle, Washington
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Thomas W. Ferkol
- Department of Pediatrics, University of North Carolina School of Medicine, UNC Children’s, Chapel Hill, North Carolina
| | - Adam J. Shapiro
- McGill University Health Centre Research Institute, Montreal Children’s Hospital, Montreal, Quebec, Canada
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3
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Benchimol L, Bouchain O, Bricmont N, Bonhiver R, Kempeneers C, Lefebvre P, Poirrier AL. Ciliary Functional Analysis in Chronic Rhinosinusitis with Polyps after Multimodal Intervention: Oral Corticosteroid, Functional Endoscopic Sinus Surgery, and Omalizumab Injection. Case Rep Otolaryngol 2024; 2024:5559001. [PMID: 38774124 PMCID: PMC11108692 DOI: 10.1155/2024/5559001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/31/2024] [Accepted: 05/03/2024] [Indexed: 05/24/2024] Open
Abstract
In her late 50 s, a woman with a medical history of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP) experienced a relapse of nasal polyps, significantly impacting her breathing and sense of smell. She underwent a multifaceted treatment approach, including oral corticosteroids, functional endoscopic sinus surgery, and omalizumab injections. Digital high-speed videomicroscopy (DHSV) revealed only partial improvement in ciliary beat pattern and ciliary beat frequency with oral corticosteroid treatment, while significant improvement in these ciliary parameters was observed with omalizumab injections. Furthermore, administration of omalizumab resulted in a decrease in her SNOT-22 (Sinonasal Outcome Test 22) score. Notably, this case report represents the first study investigating ciliary function using DHSV in a patient treated with omalizumab.
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Affiliation(s)
- Lionel Benchimol
- Centre Hospitalier Universitaire de Liège, Avenue de l'Hôpital 1, Liège, Belgium
| | - Olivier Bouchain
- Centre Hospitalier Universitaire de Liège, Avenue de l'Hôpital 1, Liège, Belgium
| | - Noemie Bricmont
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, Liège 4000, Belgium
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège 4000, Belgium
| | - Romane Bonhiver
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, Liège 4000, Belgium
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège 4000, Belgium
| | - Celine Kempeneers
- Pneumology Laboratory, I3 Group, GIGA Research Center, University of Liège, Liège 4000, Belgium
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège 4000, Belgium
| | - Philippe Lefebvre
- Centre Hospitalier Universitaire de Liège, Avenue de l'Hôpital 1, Liège, Belgium
| | - Anne-Lise Poirrier
- Centre Hospitalier Universitaire de Liège, Avenue de l'Hôpital 1, Liège, Belgium
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De Jesús-Rojas W, Demetriou ZJ, Muñiz-Hernández J, Rosario-Ortiz G, Quiñones FM, Ramos-Benitez MJ, Mosquera RA. Advancing Primary Ciliary Dyskinesia Diagnosis through High-Speed Video Microscopy Analysis. Cells 2024; 13:567. [PMID: 38607006 PMCID: PMC11011699 DOI: 10.3390/cells13070567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
Primary ciliary dyskinesia (PCD) is an inherited disorder that impairs motile cilia, essential for respiratory health, with a reported prevalence of 1 in 16,309 within Hispanic populations. Despite 70% of Puerto Rican patients having the RSPH4A [c.921+3_921+6del (intronic)] founder mutation, the characterization of the ciliary dysfunction remains unidentified due to the unavailability of advanced diagnostic modalities like High-Speed Video Microscopy Analysis (HSVA). Our study implemented HSVA for the first time on the island as a tool to better diagnose and characterize the RSPH4A [c.921+3_921+6del (intronic)] founder mutation in Puerto Rican patients. By applying HSVA, we analyzed the ciliary beat frequency (CBF) and pattern (CBP) in native Puerto Rican patients with PCD. Our results showed decreased CBF and a rotational CBP linked to the RSPH4A founder mutation in Puerto Ricans, presenting a novel diagnostic marker that could be implemented as an axillary test into the PCD diagnosis algorithm in Puerto Rico. The integration of HSVA technology in Puerto Rico substantially enhances the PCD evaluation and diagnosis framework, facilitating prompt detection and early intervention for improved disease management. This initiative, demonstrating the potential of HSVA as an adjunctive test within the PCD diagnostic algorithm, could serve as a blueprint for analogous developments throughout Latin America.
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Affiliation(s)
- Wilfredo De Jesús-Rojas
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (Z.J.D.); (G.R.-O.); (F.M.Q.)
| | - Zachary J. Demetriou
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (Z.J.D.); (G.R.-O.); (F.M.Q.)
| | - José Muñiz-Hernández
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, PR 00725, USA;
| | - Gabriel Rosario-Ortiz
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (Z.J.D.); (G.R.-O.); (F.M.Q.)
| | - Frances M. Quiñones
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (Z.J.D.); (G.R.-O.); (F.M.Q.)
| | - Marcos J. Ramos-Benitez
- Department of Pediatrics and Basic Science, Ponce Health Sciences University, Ponce, PR 00716, USA; (Z.J.D.); (G.R.-O.); (F.M.Q.)
| | - Ricardo A. Mosquera
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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Pifferi M, Boner AL, Cangiotti A, Cudazzo A, Maj D, Gracci S, Michelucci A, Bertini V, Piazza M, Valetto A, Caligo MA, Peroni D, Bush A. The genetic framework of primary ciliary dyskinesia assessed by soft computing analysis. Pediatr Pulmonol 2024. [PMID: 38169302 DOI: 10.1002/ppul.26842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND International guidelines disagree on how best to diagnose primary ciliary dyskinesia (PCD), not least because many tests rely on pattern recognition. We hypothesized that quantitative distribution of ciliary ultrastructural and motion abnormalities would detect most frequent PCD-causing groups of genes by soft computing analysis. METHODS Archived data on transmission electron microscopy and high-speed video analysis from 212 PCD patients were re-examined to quantitate distribution of ultrastructural (10 parameters) and functional ciliary features (4 beat pattern and 2 frequency parameters). The correlation between ultrastructural and motion features was evaluated by blinded clustering analysis of the first two principal components, obtained from ultrastructural variables for each patient. Soft computing was applied to ultrastructure to predict ciliary beat frequency (CBF) and motion patterns by a regression model. Another model classified the patients into the five most frequent PCD-causing gene groups, from their ultrastructure, CBF and beat patterns. RESULTS The patients were subdivided into six clusters with similar values to homologous ultrastructural phenotype, motion patterns, and CBF, except for clusters 1 and 4, attributable to normal ultrastructure. The regression model confirmed the ability to predict functional ciliary features from ultrastructural parameters. The genetic classification model identified most of the different groups of genes, starting from all quantitative parameters. CONCLUSIONS Applying soft computing methodologies to PCD diagnostic tests optimizes their value by moving from pattern recognition to quantification. The approach may also be useful to evaluate atypical PCD, and novel genetic abnormalities of unclear disease-producing potential in the future.
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Affiliation(s)
- Massimo Pifferi
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | - Attilio L Boner
- Pediatric Unit, Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Verona University Medical School, Verona, Italy
| | - Angela Cangiotti
- Electron Microscopy Unit, Department of Experimental and Clinical Medicine, University Hospital of Ancona, Ancona, Italy
| | | | - Debora Maj
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | - Serena Gracci
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | - Angela Michelucci
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Veronica Bertini
- Section of Cytogenetics, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Michele Piazza
- Pediatric Unit, Department of Surgical Science, Dentistry, Gynecology and Pediatrics, Verona University Medical School, Verona, Italy
| | - Angelo Valetto
- Section of Cytogenetics, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Maria Adelaide Caligo
- Unit of Molecular Genetics, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
| | - Diego Peroni
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
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Jõgi NO, Ersson K, Alving K, Krantz C, Malinovschi A. Device comparison study to measure nasal nitric oxide in relation to primary ciliary dyskinesia. J Breath Res 2023; 18:011001. [PMID: 38088381 DOI: 10.1088/1752-7163/ad10f9] [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: 07/07/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a genetic respiratory disease characterized by chronic cough, recurrent respiratory infections, and rhinosinusitis. The measurement of nasal nitric oxide (nNO) against resistance has been suggested as a sensitive screening method. However, current recommendations argue for the use of expensive, chemiluminescence devices to measure nNO. This study aimed to compare nNO measurement using three different devices in distinguishing PCD patients from healthy controls and cystic fibrosis (CF) patients and to evaluate their diagnostic precision. The study included 16 controls, 16 PCD patients, and 12 CF patients matched for age and sex. nNO measurements were performed using a chemiluminescence device (Eco Medics CLD 88sp), and two devices based on electrochemical sensors (Medisoft FeNO+ and NIOX Vero) following standardized guidelines. Correlation estimation, Bland-Altman, ROC curve, and one-way ANOVA were used to assess device differences and diagnostic performance. Significantly lower nNO output values were observed in PCD and CF patients compared to controls during exhalation against resistance. The correlation analysis showed high agreement among the three devices. ROC curve analysis demonstrated 100% sensitivity and specificity at different cut-off values for all devices in distinguishing PCD patients from controls (optimal cut-offs: EcoMedics 73, Medisoft 92 and NIOX 87 (nl min-1)). Higher nNO output values were obtained with the Medisoft and NIOX devices as compared to the EcoMedics device, with a bias of-19 nl min-1(95% CI: -73-35) and -21 nl min-1(-73-31) accordingly. These findings indicate that all three tested devices can potentially serve as diagnostic tools for PCD if device specific cut-off values are used. This last-mentioned aspect warrants further studies and consideration in defining optimal cut-offs for individual device.
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Affiliation(s)
- Nils Oskar Jõgi
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Ersson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Krantz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Lu D, Yang W, Zhang R, Li Y, Cheng T, Liao Y, Chen L, Liu H. Clinical Characteristics and Immune Responses in Children with Primary Ciliary Dyskinesia during Pneumonia Episodes: A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1727. [PMID: 38002818 PMCID: PMC10670724 DOI: 10.3390/children10111727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE This study explored the clinical features and immune responses of children with primary ciliary dyskinesia (PCD) during pneumonia episodes. METHODS The 61 children with PCD who were admitted to hospital because of pneumonia were retrospectively enrolled into this study between April 2017 and August 2022. A total of 61 children with pneumonia but without chronic diseases were enrolled as the control group. The clinical characteristics, levels of inflammatory indicators, pathogens, and imaging features of the lungs were compared between the two groups. RESULTS The PCD group had higher levels of lymphocytes (42.80% versus 36.00%, p = 0.029) and eosinophils (2.40% versus 1.25%, p = 0.020), but lower neutrophil counts (3.99 versus 5.75 × 109/L, p = 0.011), percentages of neutrophils (46.39% versus 54.24%, p = 0.014), CRP (0.40 versus 4.20 mg/L, p < 0.001) and fibrinogen (257.50 versus 338.00 mg/dL, p = 0.010) levels. Children with PCD and children without chronic diseases were both most commonly infected with Mycoplasma pneumoniae (24.6% versus 51.9%). Children with PCD had significantly more common imaging features, including mucous plugging (p = 0.042), emphysema (p = 0.007), bronchiectasis (p < 0.001), mosaic attenuation (p = 0.012), interstitial inflammation (p = 0.015), and sinusitis (p < 0.001). CONCLUSION PCD is linked to immune system impairment, which significantly contributes to our understanding of the pathophysiology of this entity.
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Affiliation(s)
- Danli Lu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610000, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Wenhao Yang
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610000, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Rui Zhang
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Yan Li
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Tianyu Cheng
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610000, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Yue Liao
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Lina Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610000, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu 610000, China
| | - Hanmin Liu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610000, China
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, School of Life Sciences of Fudan University, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu 610000, China
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu 610000, China
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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.
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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
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9
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Kempeneers C, Bonhiver R, Bricmont N, Pirotte M, Engelskirchen S, Benchimol L, Calmes D, Guissard F, Moermans C, Seghaye MC, Louis R, Schleich F. Ciliary dyskinesia in severe asthma is not affected by chronic mucus hypersecretion. ERJ Open Res 2023; 9:00220-2023. [PMID: 37868147 PMCID: PMC10588802 DOI: 10.1183/23120541.00220-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/09/2023] [Indexed: 10/24/2023] Open
Abstract
Chronic mucus hypersecretion (CMH) is linked to increased asthma severity. Ciliary dyskinesia is present in severe asthma but CMH was not associated with a worse ciliary dysfunction, suggesting another mechanism to explain chronic cough and phlegm. https://bit.ly/3JNUgGr.
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Affiliation(s)
- Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
| | - Romane Bonhiver
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
| | - Noëmie Bricmont
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
| | - Maud Pirotte
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Sara Engelskirchen
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
| | | | - Doriane Calmes
- Department of Pneumology, University Hospital Liège, Liège, Belgium
| | | | - Catherine Moermans
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
- Department of Pneumology, University Hospital Liège, Liège, Belgium
| | - Marie-Christine Seghaye
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
- Division of Cardiology, Department of Pediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | - Renaud Louis
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
- Department of Pneumology, University Hospital Liège, Liège, Belgium
| | - Florence Schleich
- Pneumology laboratory, I3 Group, GIGA Research Center, University of Liège, Liège, Belgium
- Department of Pneumology, University Hospital Liège, Liège, Belgium
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10
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Raidt J, Loges NT, Olbrich H, Wallmeier J, Pennekamp P, Omran H. Primary ciliary dyskinesia. Presse Med 2023; 52:104171. [PMID: 37516247 DOI: 10.1016/j.lpm.2023.104171] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Primary ciliary dyskinesia (PCD, ORPHA:244) is a group of rare genetic disorders characterized by dysfunction of motile cilia. It is phenotypically and genetically heterogeneous, with more than 50 genes involved. Thanks to genetic, clinical, and functional characterization, immense progress has been made in the understanding and diagnosis of PCD. Nevertheless, it is underdiagnosed due to the heterogeneous phenotype and complexity of diagnosis. This review aims to help clinicians navigate this heterogeneous group of diseases. Here, we describe the broad spectrum of phenotypes associated with PCD and address pitfalls and difficult-to-interpret findings to avoid misinterpretation. METHOD Review of literature CONCLUSION: PCD diagnosis is complex and requires integration of history, clinical picture, imaging, functional and structural analysis of motile cilia and, if available, genetic analysis to make a definitive diagnosis. It is critical that we continue to expand our knowledge of this group of rare disorders to improve the identification of PCD patients and to develop evidence-based therapeutic approaches.
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Affiliation(s)
- Johanna Raidt
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Niki Tomas Loges
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Heike Olbrich
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Petra Pennekamp
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
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11
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Marthin JK, Nielsen KG, Mortensen J. Quantitative 99mTc-albumin colloid nasal mucociliary clearance as an outcome in primary ciliary dyskinesia. ERJ Open Res 2023; 9:00345-2023. [PMID: 37701364 PMCID: PMC10493710 DOI: 10.1183/23120541.00345-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 09/14/2023] Open
Abstract
Background Primary ciliary dyskinesia (PCD) is an inherited disorder in which dyskinetic cilia cause impaired mucociliary clearance of upper and lower airways. Airway ciliary movement can be indirectly tested in vivo after administration of a radiolabelled tracer to the lower airways for assessment of pulmonary mucociliary clearance or to the nose for assessing nasal mucociliary clearance (NMC). With this study, we investigated NMC as a quantifiable study outcome parameter in patients with PCD. Material and methods This single centre proof-of-concept study on NMC velocity investigated patients with PCD across different genotypes and nasal nitric oxide (nasal NO) levels. Healthy controls were used for comparison. NMC was determined as velocity in mm·min-1 of a nasally applied 99mTc-albumin colloid tracer. Using a gamma camera, repeated dynamic series of images each lasting 30 s were acquired during a 10-minute period and digitally stored. Results NMC velocity was investigated in seven patients with PCD (aged 9-31 years) and five adult healthy controls. Mean NMC velocity in healthy controls (8.5 mm·min-1) was significantly higher compared with people with PCD (0.00 mm·min-1, p<0.0001). NMC was completely absent in all included patients with PCD across different PCD genotypes and regardless of nasal NO values. The success rate of the test was 100% in both groups. Conclusion NMC velocity discriminated highly significantly between patients with PCD and healthy controls. We suggest here a fast and feasible set up for NMC measurements that is easily applicable for any clinical trial involving PCD medication aimed for the nasal compartment, a step before or parallel to conducting clinical trials investigating whole-lung ciliary function in PCD.
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Affiliation(s)
- June K. Marthin
- Danish PCD Centre, Paediatric Pulmonary Service, ERN Accredited, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim G. Nielsen
- Danish PCD Centre, Paediatric Pulmonary Service, ERN Accredited, Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Shared senior authorship
| | - Jann Mortensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, The National Hospital, Torshavn, The Faroe Islands
- Shared senior authorship
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12
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Ullmann N, Santamaria F, Allegorico A, Fainardi V, Borrelli M, Ferraro VA, Proietti E, Parisi GF, Romagnoli V, Lucca F, Gallucci M, Mappa L, Lelli M, Amato D, Petrarca L, Cimino G, Sacco O, Calogero C, Patria MF, Acquafredda A, Ferlisi A, Maschio M, Kantar A, Cutrera R. Primary ciliary dyskinesia: A multicenter survey on clinical practice and patient management in Italy. Pediatr Pulmonol 2023; 58:1127-1135. [PMID: 36588099 DOI: 10.1002/ppul.26303] [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: 02/27/2022] [Revised: 09/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION There are no recent data on primary ciliary dyskinesia (PCD) distribution, diagnosis and treatment in Italy. METHODS A descriptive study based on a survey questionnaire. It consisted of three sections (patients, diagnosis, and treatment), and sent to all the Italian PCD Centers. RESULTS Questionnaires obtained from 20/22 centers in 12/20 regions showed that the total number of PCD patients treated at the participating centers was of 416. Out of all centers, 55% follow <20 patients, two centers have >40 patients, and 75% follow both pediatric and adults. Age at diagnosis was between 4 and 8 years in 45% of the centers, <3 years in three centers. Nasal nitric oxide, transmission electron microscopy and ciliary high-speed video microscopy are performed in 75%, 90%, and 40% of centers, respectively. Immunofluorescence is available in five centers. Genetic analysis is offered in 55% of the centers, and in seven centers >50% of the patients have a known genetic profile. Patients treated at all centers receive inhaled saline solutions, corticosteroids and chest physiotherapy. Prophylactic antibiotics and mucolytics are prescribed in 95% and 50% of the centers, respectively. Pseudomonas infection is treated with oral or inhaled antibiotics. CONCLUSIONS Many Italian centers care for a small number of pediatric and adult patients, and diagnosis is often delayed. We found a great variability in the available diagnostic procedures, as well in the prescribed therapies. Our study will help to uniform diagnostic algorithm and share treatments protocols for PCD in Italy and allowed to set specific national goals.
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Affiliation(s)
- Nicola Ullmann
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy
| | - Annalisa Allegorico
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Fainardi
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Pediatric Pulmonology, Federico II University, Naples, Italy
| | - Valentina A Ferraro
- Department of Women's and Children's Health, University of Padua, Padova, Italy
| | | | - Giuseppe F Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Vittorio Romagnoli
- Department of Mother and Child Health, Pediatric Unit, G. Salesi Children's Hospital, Ancona, Italy
| | - Francesca Lucca
- Cystic Fibrosis Centre, Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, Italy
| | - Marcella Gallucci
- Pediatric Unit-IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Mappa
- Department of Interdisciplinary Medicine (D.I.M.), Pediatric Unit "Trambusti" Cystic Fibrosis, University of Bari, Bari, Italy
| | - Mara Lelli
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Doriana Amato
- Department of Pediatrics, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cimino
- Cystic Fibrosis Regional Reference Center, A.O.U. Policlinico Umberto I, Rome, Italy
| | - Oliviero Sacco
- Department of Pediatrics, Pulmonary Disease Unit, G. Gaslini Research Institute and University Hospital, Genoa, Italy
| | - Claudia Calogero
- Pediatric Pulmonary Unit, Meyer Children's University Hospital, Florence, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annalisa Ferlisi
- Cystic Fibrosis and Respiratory Pediatric Center, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Massimo Maschio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi - Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Adaikalam S, Gaston B. Mucus Plugging in Primary Ciliary Dyskinesia. Ann Am Thorac Soc 2023; 20:514-515. [PMID: 37000147 PMCID: PMC10112401 DOI: 10.1513/annalsats.202301-021ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Stephanie Adaikalam
- Riley Hospital for Children and the Herman B. Wells Center for Pediatric Research, Indianapolis, Indiana
| | - Benjamin Gaston
- Riley Hospital for Children and the Herman B. Wells Center for Pediatric Research, Indianapolis, Indiana
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14
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Luongo FP, Luddi A, Ponchia R, Ferrante R, Di Rado S, Paccagnini E, Gentile M, Lupetti P, Guazzo R, Orrico A, Stuppia L, Piomboni P. Case report: The CCDC103 variant causes ultrastructural sperm axonemal defects and total sperm immotility in a professional athlete without primary ciliary diskinesia. Front Genet 2023; 14:1062326. [PMID: 36777727 PMCID: PMC9908957 DOI: 10.3389/fgene.2023.1062326] [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] [Received: 10/05/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder characterized by abnormal ciliary motion, due to a defect in ciliary structure and/or function. This genetic condition leads to recurrent upper and lower respiratory infections, bronchiectasis, laterality defect, and subfertility. Male infertility is often associated with PCD, since the ultrastructure of the axoneme in the sperm tail is similar to that of the motile cilia of respiratory cells. We present the first reported case of a male patient from a non-consanguineous Italian family who exhibited a severe form of asthenozoospermia factor infertility but no situs inversus and absolutely no signs of the clinical respiratory phenotype, the proband being a professional basketball player. Whole-exome sequencing (WES) has identified a homozygote mutation (CCDC103 c.461 A>C, p.His154Pro) in the proband, while his brother was a heterozygous carrier for this mutation. Morphological and ultrastructural analyses of the axoneme in the sperm flagellum demonstrated the complete loss of both the inner and outer dynein arms (IDA and ODA, respectively). Moreover, immunofluorescence of DNAH1, which is used to check the assembly of IDA, and DNAH5, which labels ODA, demonstrated that these complexes are absent along the full length of the flagella in the spermatozoa from the proband, which was consistent with the IDA and ODA defects observed. Noteworthy, TEM analysis of the axoneme from respiratory cilia showed that dynein arms, although either IDAs and/or ODAs seldom missing on some doublets, are still partly present in each observed section. This case reports the total sperm immotility associated with the CCDC103 p.His154Pro mutation in a man with a normal respiratory phenotype and enriches the variant spectrum of ccdc103 variants and the associated clinical phenotypes in PCD, thus improving counseling of patients about their fertility and possible targeted treatments.
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Affiliation(s)
| | - Alice Luddi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,*Correspondence: Alice Luddi,
| | - Rosetta Ponchia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Rossella Ferrante
- Department of Psychological Sciences, Health and Territory, University of Chieti-Pescara, Chieti, Italy
| | - Sara Di Rado
- Department of Psychological Sciences, Health and Territory, University of Chieti-Pescara, Chieti, Italy
| | | | | | - Pietro Lupetti
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Alfredo Orrico
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Liborio Stuppia
- Department of Psychological Sciences, Health and Territory, University of Chieti-Pescara, Chieti, Italy
| | - Paola Piomboni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy,Assisted Reproductive Unit, Siena University Hospital, Siena, Italy
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15
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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.
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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
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Chau JFT, Lee M, Chui MMC, Yu MHC, Fung JLF, Mak CCY, Chau CSK, Siu KK, Hung J, Yeung KS, Kwong AKY, O'Callaghan C, Lau YL, Lee CWD, Chung BHY, Lee SL. Functional Evaluation and Genetic Landscape of Children and Young Adults Referred for Assessment of Bronchiectasis. Front Genet 2022; 13:933381. [PMID: 36003331 PMCID: PMC9393783 DOI: 10.3389/fgene.2022.933381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/23/2022] [Indexed: 11/14/2022] Open
Abstract
Bronchiectasis is the abnormal dilation of the airway which may be caused by various etiologies in children. Beyond the more recognized cause of bacterial and viral infections and primary immunodeficiencies, other genetic conditions such as cystic fibrosis and primary ciliary dyskinesia (PCD) can also contribute to the disease. Currently, there is still debate on whether genome sequencing (GS) or exome sequencing reanalysis (rES) would be beneficial if the initial targeted testing results returned negative. This study aims to provide a back-to-back comparison between rES and GS to explore the best integrated approach for the functional and genetics evaluation for patients referred for assessment of bronchiectasis. In phase 1, an initial 60 patients were analyzed by exome sequencing (ES) with one additional individual recruited later as an affected sibling for ES. Functional evaluation of the nasal nitric oxide test, transmission electron microscopy, and high-speed video microscopy were also conducted when possible. In phase 2, GS was performed on 30 selected cases with trio samples available. To provide a back-to-back comparison, two teams of genome analysts were alternatively allocated to GS or rES and were blinded to each other’s analysis. The time for bioinformatics, analysis, and diagnostic utility was recorded for evaluation. ES revealed five positive diagnoses (5/60, 8.3%) in phase 1, and four additional diagnoses were made by rES and GS (4/30, 13%) during phase 2. Subsequently, one additional positive diagnosis was identified in a sibling by ES and an overall diagnostic yield of 10/61 (16.4%) was reached. Among those patients with a clinical suspicion of PCD (n = 31/61), the diagnostic yield was 26% (n = 8/31). While GS did not increase the diagnostic yield, we showed that a variant of uncertain significance could only be detected by GS due to improved coverage over ES and hence is a potential benefit for GS in the future. We show that genetic testing is an essential component for the diagnosis of early-onset bronchiectasis and is most effective when used in combination with functional tools such as TEM or HSVM. Our comparison of rES vs. GS suggests that rES and GS are comparable in clinical diagnosis.
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Affiliation(s)
- Jeffrey Fong Ting Chau
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Mianne Lee
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Martin Man Chun Chui
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Mullin Ho Chung Yu
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Jasmine Lee Fong Fung
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Christopher Chun Yu Mak
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Christy Shuk-Kuen Chau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Ka Ka Siu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Jacqueline Hung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Kit San Yeung
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Anna Ka Yee Kwong
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Christopher O'Callaghan
- UCL Great Ormond Street Institute of Child Health, UCL and GOSH NIHR BRC, London, United Kingdom
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Chun-Wai Davy Lee
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Duchess of Kent Children’s Hospital, Pok Fu Lam, Hong Kong SAR, China
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Duchess of Kent Children’s Hospital, Pok Fu Lam, Hong Kong SAR, China
- *Correspondence: Brian Hon-Yin Chung, ; So-Lun Lee,
| | - So-Lun Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China
- *Correspondence: Brian Hon-Yin Chung, ; So-Lun Lee,
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Peng B, Gao YH, Xie JQ, He XW, Wang CC, Xu JF, Zhang GJ. Clinical and genetic spectrum of primary ciliary dyskinesia in Chinese patients: a systematic review. Orphanet J Rare Dis 2022; 17:283. [PMID: 35854386 PMCID: PMC9295413 DOI: 10.1186/s13023-022-02427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) represents a highly heterogenous disorder with extensive clinical and genetic patterns among populations of different geographic location and ethnic origin. However, data about Chinese patients are limited. We aimed to summarize the clinical and genetic spectrum of Chinese PCD patients based on all available literatures. Methods We searched Embase, Pubmed, Web of Science and Chinese databases including CNKI, SinoMed and Wanfang from 1981 to 2021, to identify articles reporting patients with PCD in China, which had included information about transmission electron microscopy and/or genetic testing. Results A total of 244 Chinese PCD patients in 52 articles were included. Of these patients, the mean age was 13.1 years, and 55 patients (22.5%) were diagnosed with PCD after 18 years old. Compared with patients diagnosed with PCD in childhood or infancy, patients diagnosed with PCD in adulthood had a higher prevalence of chronic wet cough, sinusitis, Pseudomonas aeruginosa (PA) isolation and radiological bronchiectasis as well as worse lung function. 25 PCD-related genes were identified in 142 patients, and DNAH5, DNAH11, CCDC39 and CCDC40 were the most frequently detected mutations. More than half of genetic variants were loss-of-function mutations, and the majority of these variants were seen only once. Correlations between PCD phenotype, genotype and ciliary ultrastructure were also evidenced. Conclusions Diagnostic delay and under-recognition of PCD remain a big issue in China, which contributes to progressive lung disease and PA infection indicating worse outcome. Specialist equipment and expertise are urgently required to facilitate the early diagnosis and treatment of PCD. Trial registry PROSPERO; No.: CRD42021257804; URL:www.crd.york.ac.uk/prospero/ Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02427-1.
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Affiliation(s)
- Bo Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China.
| | - Jia-Qi Xie
- Department of Respiratory and Critical Care Medicine, Xiangyang Central Hospital, Xiangyang, China
| | - Xiao-Wen He
- Department of Respiratory and Critical Care Medicine, Xuchang Central Hospital, Xuchang, China
| | - Cong-Cong Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Guo-Jun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
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Challenges in Diagnosing Primary Ciliary Dyskinesia in a Brazilian Tertiary Hospital. Genes (Basel) 2022; 13:genes13071252. [PMID: 35886035 PMCID: PMC9324289 DOI: 10.3390/genes13071252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/27/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) causes cellular cilia motility alterations, leading to clinical manifestations in the upper and lower respiratory tract and situs abnormalities. The PCD diagnosis was improved after the inclusion of diagnostic tools, such as transmission electron microscopy and genetic screening; however, the PCD screening is a challenge yet. In this context, we aimed to describe the clinical, genetic, and ultra-ciliary characteristics in individuals with clinical suspicion of PCD (cPCD) from a Brazilian Tertiary Hospital. An observational study was carried out with individuals during the follow-up between 2011 and 2021. The individuals were submitted to clinical questionnaires, transmission electron microscopy, and genetic screening for pathogenic variants in PCD-related genes. Those patients were classified according to the degree of suspicion for PCD. In our study, we enrolled thirty-seven cPCD individuals; 20/37 (54.1%) had chronic rhinosinusitis, 28/37 (75.6%) had bronchiectasis, and 29/37 (78.4%) had recurrent pneumonia. A total of 17/37 (45.9%) individuals had transmission electron microscopy or genetic confirmation of PCD; 10 individuals had at least one positive pathogenic genetic variant in the PCD-related genes; however, only seven patients presented a conclusive result according to the American College of Medical Genetics and Genomics and the Association for Molecular Pathology with two pathogenic variants in homozygous or compound heterozygous. The median age at diagnosis was 13 years, and the median time between suspicion and diagnosis was four years. Sixteen patients had class I electron microscopy alterations, seven had class II alterations, and 14 had normal transmission electron microscopy according to the international consensus guideline for reporting transmission electron microscopy results in the diagnosis of PCD (BEAT-PCD TEM Criteria). Genetic screening for pathogenic variants in PCD-related genes and transmission electron microscopy can help determine the PCD diagnosis; however, they are still unavailable to all individuals with clinical suspicion in Brazil. We described ultrastructural alterations found in our population along with the identification of pathogenic variants in PCD-related genes.
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Amirav I, Shoshan NB, Behan L, Bar-Yoseph R, Lavie M. Translation of the quality of life questionnaire for primary ciliary dyskinesia (QOL-PCD) into Hebrew: The Israeli experience. Pediatr Pulmonol 2022; 57:1331-1338. [PMID: 35174672 PMCID: PMC9314800 DOI: 10.1002/ppul.25864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/19/2022] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with primary ciliary dyskinesia (PCD) have chronic morbidities affecting their quality of life (QOL). Health-related QOL (HRQOL) has been recognized as an important tool for assessing the burden of PCD on patients and their families. A PCD-specific HRQOL questionnaire (QOL-PCD) was developed and validated for the English-speaking populations. Still, it has not yet been translated into Hebrew or adapted for Israeli PCD patients. METHODS This describes our translation of the original English version of QOL-PCD into a Hebrew version. The process involved forward translation by independent translators, construction of a consensus version, back-translation into the original English version, analysis by the expert committee, and a pretest. The pretest was administered to 20 participants with PCD (the patients and the parents of minor patients) to assess the feasibility and practicality of the tool. Scale and item indices (scale-level content validity index [S-CVI] and item-level content validity index [I-CVI]) were calculated for content validity. RESULTS All study participants understood the final Hebrew version that the expert committee had approved with no difficulty. The instrument had satisfactory (>0.80) content validity, with S-CVI indexes of 0.99 for the adult version, 0.86 for the parental version, 0.95 for the adolescent version, and 1.00 for the child version. CONCLUSION The English version of a QOL-PCD was translated into Hebrew and adapted in Israel. This translation is a valid instrument to assess HRQOL in Hebrew-speaking patients with PCD and their family members. It may be helpful for PCD patient management and research in Israel.
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Affiliation(s)
- Israel Amirav
- Pediatric Pulmonology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa B Shoshan
- Pediatric Pulmonology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura Behan
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel, Affiliated with the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moran Lavie
- Pediatric Pulmonology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Alzaid M, Al-Mobaireek K, Almannai M, Mukhtar G, Eltahir S, Zafar A, Zada AP, Alotaibi W. Clinical and molecular characteristics of primary ciliary dyskinesia: A tertiary care centre experience. Int J Pediatr Adolesc Med 2021; 8:258-263. [PMID: 34401452 PMCID: PMC8356118 DOI: 10.1016/j.ijpam.2021.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a ciliopathy with diverse clinical and genetic findings caused by abnormal motile cilia structure and function. In this study, we describe the clinical characteristics of confirmed PCD cases in our population and report the radiological, genetic, and laboratory findings. METHODS This was a retrospective, observational, single-centre study. We enrolled 18 patients who were diagnosed with confirmed PCD between 2015 and 2019. We then analyzed their data, including clinical findings and workup. RESULTS In our cohort, 56% of patients had molecularly confirmed PCD, and RSPH9 was the most common gene identified. Transmission electron microscopy (TEM) showed an ultrastructural defect in 64% of samples, all of which matched the genetic background of the patient. Situs inversus (SI) was observed in 50% of patients, and congenital heart disease was observed in 33%. The median body mass index (BMI) was 15.87 kg/m2, with a median z score of -1.48. The median FEV1 value was 67.6% (z score - 2.43). Radiologically, bronchiectasis was noted in 81% of patients at a variable degree of severity. Lung bases were involved in 91% of patients. We were unable to correlate the genotype-phenotype findings. CONCLUSION We describe the clinical and molecular characteristics of patients with confirmed PCD in a tertiary centre in Saudi Arabia and report 9 new pathogenic or likely pathogenic variants in one of the PCD-associated genes.
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Affiliation(s)
- Mohammed Alzaid
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
- Corresponding author. Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, PO Box 13514, Saudi Arabia.
| | - Khalid Al-Mobaireek
- Pulmonary Division of the Pediatric Department, King Khalid University Hospital, Saudi Arabia
| | - Mohammed Almannai
- Genetic and Metabolic Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Gawahir Mukhtar
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Safa Eltahir
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | - Adnan Zafar
- Pulmonary Division of the Pediatric Department, Children Specialized Hospital, King Fahad Medical City, Saudi Arabia
| | | | - Wadha Alotaibi
- Pathology Department, Kind Fahad Medical City, Saudi Arabia
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22
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Nussbaumer M, Kieninger E, Tschanz SA, Savas ST, Casaulta C, Goutaki M, Blanchon S, Jung A, Regamey N, Kuehni CE, Latzin P, Müller L. Diagnosis of primary ciliary dyskinesia: discrepancy according to different algorithms. ERJ Open Res 2021; 7:00353-2021. [PMID: 34729370 PMCID: PMC8558472 DOI: 10.1183/23120541.00353-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Background Diagnosis of primary ciliary dyskinesia (PCD) is challenging since there is no gold standard test. The European Respiratory (ERS) and American Thoracic (ATS) Societies developed evidence-based diagnostic guidelines with considerable differences. Objective We aimed to compare the algorithms published by the ERS and the ATS with each other and with our own PCD-UNIBE algorithm in a clinical setting. Our algorithm is similar to the ERS algorithm with additional immunofluorescence staining. Agreement (Cohen's κ) and concordance between the three algorithms were assessed in patients with suspicion of PCD referred to our diagnostic centre. Results In 46 out of 54 patients (85%) the final diagnosis was concordant between all three algorithms (30 PCD negative, 16 PCD positive). In eight patients (15%) PCD diagnosis differed between the algorithms. Five patients (9%) were diagnosed as PCD only by the ATS, one (2%) only by the ERS and PCD-UNIBE, one (2%) only by the ATS and PCD-UNIBE, and one (2%) only by the PCD-UNIBE algorithm. Agreement was substantial between the ERS and the ATS (κ=0.72, 95% CI 0.53–0.92) and the ATS and the PCD-UNIBE (κ=0.73, 95% CI 0.53–0.92) and almost perfect between the ERS and the PCD-UNIBE algorithms (κ=0.92, 95% CI 0.80–1.00). Conclusion The different diagnostic algorithms lead to a contradictory diagnosis in a considerable proportion of patients. Thus, an updated, internationally harmonised and standardised PCD diagnostic algorithm is needed to improve diagnostics for these discordant cases. There is no gold standard test for diagnosing PCD. The use of existing diagnostic algorithms leads to contradicting results in many patients (15% in this study). Thus, an updated and internationally harmonised diagnostic guideline is needed.https://bit.ly/2U19Vvq
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Affiliation(s)
- Mirjam Nussbaumer
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | | | - Sibel T Savas
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sylvain Blanchon
- Dept Woman-Mother-Child, Service of Pediatrics, Pediatric Pulmonology and Cystic Fibrosis Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Claudia E Kuehni
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Loretta Müller
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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Progress in Diagnosing Primary Ciliary Dyskinesia: The North American Perspective. Diagnostics (Basel) 2021; 11:diagnostics11071278. [PMID: 34359360 PMCID: PMC8304305 DOI: 10.3390/diagnostics11071278] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low nNO values require confirmation with genetic testing or ciliary electron micrograph (EM) analysis. Furthermore, these guidelines recognize that not all North American patients have access to nNO testing and isolated genetic testing is appropriate in cases with strong clinical PCD phenotypes. For unresolved diagnostic cases, referral to a PCD Foundation accredited center is recommended. The purpose of this narrative review is to provide insight on the North American PCD diagnostic process, to enhance the understanding of and adherence to current guidelines, and to promote collaboration with diagnostic pathways used outside of North America.
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Abstract
Primary ciliary dyskinesia (PCD) is an inherited cause of bronchiectasis. The estimated PCD prevalence in children with bronchiectasis is up to 26% and in adults with bronchiectasis is 1 to 13%. Due to dysfunction of the multiple motile cilia of the respiratory tract patients suffer from poor mucociliary clearance. Clinical manifestations are heterogeneous; however, a typical patient presents with chronic productive cough and rhinosinusitis from early life. Other symptoms reflect the multiple roles of motile cilia in other organs and can include otitis media and hearing loss, infertility, situs inversus, complex congenital heart disease, and more rarely other syndromic features such as hydrocephalus and retinitis pigmentosa. Awareness, identification, and diagnosis of a patient with PCD are important for multidisciplinary care and genetic counseling. Diagnosis can be pursued through a multitest pathway which includes the measurement of nasal nitric oxide, sampling the nasal epithelium to assess ciliary function and structure, and genotyping. Diagnosis is confirmed by the identification of a hallmark ultrastructural defect or pathogenic mutations in one of > 45 PCD causing genes. When a diagnosis is established management is centered around improving mucociliary clearance through physiotherapy and treatment of infection with antibiotics. The first international randomized controlled trial in PCD has recently been conducted showing azithromycin is effective in reducing exacerbations. It is likely that evidence-based PCD-specific management guidelines and therapies will be developed in the near future. This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care.
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Affiliation(s)
- Amelia Shoemark
- Scottish Centre for Respiratory Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee DD1 9SY, United Kingdom.,PCD Diagnostic Service, Royal Brompton Hospital, London, United Kingdom
| | - Katharine Harman
- Department of Paediatrics and Child Health, King's College Hospital, London, United Kingdom
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25
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The Relationship between Genotype and Phenotype in Primary Ciliary Dyskinesia Patients. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:188-192. [PMID: 34349594 PMCID: PMC8298072 DOI: 10.14744/semb.2020.22567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022]
Abstract
Objectives: Primary ciliary dyskinesia (PCD) is a chronic genetic disease that affects the respiratory tract, characterized by different clinical and laboratory features. It has a very difficult diagnosis, and high morbidity. In recent years, with the advances in genetics, the rate of diagnosis has increased considerably. In this study, it was aimed to evaluate the relationship between PCD patients’ clinical, radiological and laboratory features and genetic analysis. Methods: The study included 14 children who were diagnosed with PCD between 2015-2019 and underwent exome analysis. Diagnostic ages, body mass indexes (BMI)- Z score, clinical and radiological findings, pulmonary function tests, sputum culture reproduction and gene analysis were evaluated and compared. Results: Six of the patients (43%) were girls and 8 (57%) were boys, and the median age at the time of diagnosis was 9 (min-max: 3-16) years. Genetic analysis revealed pathogenic mutations in DNAH5 (n=4, 29%), DNAH11 (n=2, 14%), RSPH4A (n=2, 14%), CCDC40 (n=2, 14%), DNAH9 (n=1, 7%), HYDIN (n=1, 7%), DNAH1 (n=1, 7%), and ARMC4 (n=1, 7%). Although not statistically significant, it was found that the diagnosis age was lower and the BMI Z-score was lower in CCDC40 mutations. Growth parametres were normal in DNAH5, DNAH11, RSPH4A and ARMC4 pathogenic variants. No significant correlation was found between genetic analysis and clinical features, culture reproduction and pulmonary function tests of the patients. Conclusion: It is thought that more detailed information about the possible clinical features and prognosis of the disease can be obtained by genetic examinations of PCD. However, clinical trials with higher patient numbers are still needed.
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Martinů V, Bořek-Dohalská L, Varényiová Ž, Uhlík J, Čapek V, Pohunek P, Koucký V. Evaluation of a Clinical Index as a Predictive Tool for Primary Ciliary Dyskinesia. Diagnostics (Basel) 2021; 11:diagnostics11061088. [PMID: 34198708 PMCID: PMC8232329 DOI: 10.3390/diagnostics11061088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In primary ciliary dyskinesia (PCD) there is no single diagnostic test. Different predictive tools have been proposed to guide referral of high-risk patients for further diagnostic workup. We aimed to test clinical index (CI) on a large unselected cohort and compare its characteristics with other widely used tools—PICADAR and NA-CDCF. Methods: CI, PICADAR, and NA-CDCF scores were calculated in 1401 patients with suspected PCD referred to our center. Their predictive characteristics were analyzed using receiver operating characteristics (ROC) curves and compared to each other. Nasal nitric oxide (nNO) was measured in 569 patients older than 3 years. Results: PCD was diagnosed in 67 (4.8%) patients. CI, PICADAR, and NA-CDCF scores were higher in PCD than in nonPCD group (all p < 0.001). The area under the ROC curve (AUC) for CI was larger than for NA-CDCF (p = 0.005); AUCPICADAR and AUCNA-CDCF did not differ (p = 0.093). An overlap in signs and symptoms among tools was identified. PICADAR could not be assessed in 86 (6.1%) patients without chronic wet cough. For CI laterality or congenital heart defects assessment was not necessary. nNO further improved predictive power of all three tools. Conclusion: CI is a feasible predictive tool for PCD that may outperform PICADAR and NA-CFCD.
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Affiliation(s)
- Vendula Martinů
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
- Correspondence: ; Tel.: +420-607617870
| | - Lucie Bořek-Dohalská
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
| | - Žofia Varényiová
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
| | - Jiří Uhlík
- Department of Histology and Embryology, Second Faculty of Medicine, Charles University, 150 00 Prague, Czech Republic;
| | - Václav Čapek
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
| | - Petr Pohunek
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
| | - Václav Koucký
- Department of Paediatrics, Second Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic; (L.B.-D.); (Ž.V.); (V.Č.); (P.P.); (V.K.)
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Rademacher J, Dettmer S, Fuge J, Vogel-Claussen J, Shin HO, Shah A, Pedro PI, Wilson R, Welte T, Wacker F, Loebinger MR, Ringshausen FC. The Primary Ciliary Dyskinesia Computed Tomography Score in Adults with Bronchiectasis: A Derivation und Validation Study. Respiration 2021; 100:499-509. [PMID: 33895745 PMCID: PMC8220914 DOI: 10.1159/000514927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare genetic disorder which requires a complex diagnostic workup. Thus, an easy and widely available screening method would be helpful to identify patients who need a further diagnostic workup for PCD. OBJECTIVES The aim of the study was to develop and validate a computed tomography (CT) score for PCD to facilitate etiological diagnosis in adults with bronchiectasis. METHOD Chest CTs from 121 adults with bronchiectasis were scored for bronchiectasis morphology, distribution, and associated findings. Patients with and without the etiological diagnosis of PCD (46 and 75, respectively) were compared. Significantly, different imaging findings (p < 0.05) in univariate analysis were considered for multivariate analysis. Distinct findings were used to build the score. Based on this score, receiver operating characteristic (ROC) curve analysis was performed. The score was validated with 2 independent cohorts, another cohort from the same institution with 56 patients (28 with PCD) and an external cohort from another referral center with 172 patients (86 with PCD). RESULTS The following parameters predicted PCD in adults with bronchiectasis and were included in the score with weighting according to their regression coefficients: 2 points were given for predominance in the middle/lower lobe, 2 points for tree-in-bud pattern, 2 points for atelectasis or prior resection of a middle/lower lobe, and 3 points for absence of emphysema and fibrosis. Situs inversus was only observed in subjects with PCD (Kartagener syndrome) and, thus, was not used in the primary ciliary dyskinesia computed tomography (PCD-CT) score as group comparisons could not be performed. ROC curve analysis revealed an area under the curve (AUC) of 0.90 (95% CI 0.85-0.96). Youden index was the highest at a threshold of >6 with a sensitivity of 83% and a specificity of 83%. In the validation cohorts, ROC curve analysis confirmed the performance of the score with an AUC of 0.83 (95% CI 0.72-0.94) in the first validation cohort and 0.79 (95% CI 0.73-0.86) in the external validation cohort. CONCLUSIONS The PCD-CT score provides the first validated CT score for PCD and helps physicians in identifying adult bronchiectasis patients who require further diagnostic workup. Key message: The PCD-CT score provides the first validated CT score to assist physicians in identifying adult bronchiectasis patients who require a further diagnostic workup for PCD. It potentially improves earlier recognition of this rare and underdiagnosed disease.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Sabine Dettmer
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany,*Sabine Dettmer,
| | - Jan Fuge
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Hoen-oh Shin
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Anand Shah
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paula Inês Pedro
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Rob Wilson
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Department of Radiology, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Michael R. Loebinger
- Host Defence Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Felix C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Hogg C, Bush A. CON: Primary Ciliary Dyskinesia diagnosis: Genes are all you need! Paediatr Respir Rev 2021; 37:34-36. [PMID: 32439130 DOI: 10.1016/j.prrv.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Claire Hogg
- Paediatric Respiratory Medicine, Imperial College, United Kingdom; Consultant Paediatric Chest Physician, Royal Brompton & Harefield Foundation Trust, United Kingdom.
| | - Andrew Bush
- Consultant Paediatric Chest Physician, Royal Brompton & Harefield Foundation Trust, United Kingdom; Paediatrics and Paediatric Respirology, Imperial College, United Kingdom
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Machogu E, Gaston B. Respiratory Distress in the Newborn with Primary Ciliary Dyskinesia. CHILDREN-BASEL 2021; 8:children8020153. [PMID: 33670529 PMCID: PMC7922088 DOI: 10.3390/children8020153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
Primary ciliary dyskinesia (PCD) is inherited in a predominantly autosomal recessive manner with over 45 currently identified causative genes. It is a clinically heterogeneous disorder that results in a chronic wet cough and drainage from the paranasal sinuses, chronic otitis media with hearing impairment as well as male infertility. Approximately 50% of patients have situs inversus totalis. Prior to the development of chronic oto-sino-pulmonary symptoms, neonatal respiratory distress occurs in more than 80% of patients as a result of impaired mucociliary clearance and mucus impaction causing atelectasis and lobar collapse. Diagnosis is often delayed due to overlapping symptoms with other causes of neonatal respiratory distress. A work up for PCD should be initiated in the newborn with compatible clinical features, especially those with respiratory distress, consistent radiographic findings or persistent oxygen requirement and/or organ laterality defects.
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Affiliation(s)
- Evans Machogu
- Correspondence: ; Tel.: +1-317-948-7208; Fax: +1-317-944-7247
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Gileles-Hillel A, Mor-Shaked H, Shoseyov D, Reiter J, Tsabari R, Hevroni A, Cohen-Cymberknoh M, Amirav I, Brammli-Greenberg S, Horani A, Kerem E, Breuer O. Whole-exome sequencing accuracy in the diagnosis of primary ciliary dyskinesia. ERJ Open Res 2020; 6:00213-2020. [PMID: 33447612 PMCID: PMC7792814 DOI: 10.1183/23120541.00213-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023] Open
Abstract
The diagnosis of primary ciliary dyskinesia (PCD) relies on clinical features and sophisticated studies. The detection of bi-allelic disease-causing variants confirms the diagnosis. However, a standardised genetic panel is not widely available and new disease-causing genes are continuously identified. To assess the accuracy of untargeted whole-exome sequencing (WES) as a diagnostic tool for PCD, patients with symptoms highly suggestive of PCD were consecutively included. Patients underwent measurement of nasal nitric oxide (nNO) levels, ciliary transmission electron microscopy analysis (TEM) and WES. A confirmed PCD diagnosis in symptomatic patients was defined as a recognised ciliary ultrastructural defect on TEM and/or two pathogenic variants in a known PCD-causing gene. Forty-eight patients (46% male) were enrolled, with a median age of 10.0 years (range 1.0–37 years). In 36 patients (75%) a diagnosis of PCD was confirmed, of which 14 (39%) patients had normal TEM. A standalone untargeted WES had a diagnostic yield of 94%, identifying bi-allelic variants in 11 known PCD-causing genes in 34 subjects. A nNO<77 nL·min was nonspecific when including patients younger than 5 years (area under the receiver operating characteristic curve (AUC) 0.75, 95% CI 0.60–0.90). Consecutive WES considerably improved the diagnostic accuracy of nNO in young children (AUC 0.97, 95% CI 0.93–1). Finally, WES established an alternative diagnosis in four patients. In patients with clinically suspected PCD and low nNO levels, WES is a simple, beneficial and accurate next step to confirm the diagnosis of PCD or suggest an alternative diagnosis, especially in preschool-aged children in whom nNO is less specific. Untargeted whole-exome sequencing in subjects with clinical symptoms highly suggestive of PCD has an excellent diagnostic accuracy and, as prices drop, may be the genetic test of choice for confirming PCD or establishing an alternative diagnosishttps://bit.ly/3j2jMbu
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Affiliation(s)
- Alex Gileles-Hillel
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hagar Mor-Shaked
- Monique and Jacques Roboh Department of Genetic Research, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Joel Reiter
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Israel Amirav
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Pediatric Pulmonology Unit, Tel Aviv, Israel
| | - Shuli Brammli-Greenberg
- The Department of Management, Policy and Health Economics, School of Public Health, The Hebrew University of Jerusalem, Israel
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Legendre M, Zaragosi LE, Mitchison HM. Motile cilia and airway disease. Semin Cell Dev Biol 2020; 110:19-33. [PMID: 33279404 DOI: 10.1016/j.semcdb.2020.11.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023]
Abstract
A finely regulated system of airway epithelial development governs the differentiation of motile ciliated cells of the human respiratory tract, conferring the body's mucociliary clearance defence system. Human cilia dysfunction can arise through genetic mutations and this is a cause of debilitating disease morbidities that confer a greatly reduced quality of life. The inherited human motile ciliopathy disorder, primary ciliary dyskinesia (PCD), can arise from mutations in genes affecting various aspects of motile cilia structure and function through deficient production, transport and assembly of cilia motility components or through defective multiciliogenesis. Our understanding about the development of the respiratory epithelium, motile cilia biology and the implications for human pathology has expanded greatly over the past 20 years since isolation of the first PCD gene, rising to now nearly 50 genes. Systems level insights about cilia motility in health and disease have been made possible through intensive molecular and omics (genomics, transcriptomics, proteomics) research, applied in ciliate organisms and in animal and human disease modelling. Here, we review ciliated airway development and the genetic stratification that underlies PCD, for which the underlying genotype can increasingly be connected to biological mechanism and disease prognostics. Progress in this field can facilitate clinical translation of research advances, with potential for great medical impact, e.g. through improvements in ciliopathy disease diagnosis, management, family counselling and by enhancing the potential for future genetically tailored approaches to disease therapeutics.
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Affiliation(s)
- Marie Legendre
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Childhood Genetic Disorders, Département de Génétique Médicale, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris 75012, France
| | | | - Hannah M Mitchison
- Genetics and Genomic Medicine, University College London, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK.
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Coles JL, Thompson J, Horton KL, Hirst RA, Griffin P, Williams GM, Goggin P, Doherty R, Lackie PM, Harris A, Walker WT, O’Callaghan C, Hogg C, Lucas JS, Blume C, Jackson CL. A Revised Protocol for Culture of Airway Epithelial Cells as a Diagnostic Tool for Primary Ciliary Dyskinesia. J Clin Med 2020; 9:E3753. [PMID: 33233428 PMCID: PMC7700393 DOI: 10.3390/jcm9113753] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
Air-liquid interface (ALI) culture of nasal epithelial cells is a valuable tool in the diagnosis and research of primary ciliary dyskinesia (PCD). Ex vivo samples often display secondary dyskinesia from cell damage during sampling, infection or inflammation confounding PCD diagnostic results. ALI culture enables regeneration of healthy cilia facilitating differentiation of primary from secondary ciliary dyskinesia. We describe a revised ALI culture method adopted from April 2018 across three collaborating PCD diagnostic sites, including current University Hospital Southampton COVID-19 risk mitigation measures, and present results. Two hundred and forty nasal epithelial cell samples were seeded for ALI culture and 199 (82.9%) were ciliated. Fifty-four of 83 (63.9%) ex vivo samples which were originally equivocal or insufficient provided diagnostic information following in vitro culture. Surplus basal epithelial cells from 181 nasal brushing samples were frozen in liquid nitrogen; 39 samples were ALI-cultured after cryostorage and all ciliated. The ciliary beat patterns of ex vivo samples (by high-speed video microscopy) were recapitulated, scanning electron microscopy demonstrated excellent ciliation, and cilia could be immuno-fluorescently labelled (anti-alpha-tubulin and anti-RSPH4a) in representative cases that were ALI-cultured after cryostorage. In summary, our ALI culture protocol provides high ciliation rates across three centres, minimising patient recall for repeat brushing biopsies and improving diagnostic certainty. Cryostorage of surplus diagnostic samples was successful, facilitating PCD research.
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Affiliation(s)
- Janice L. Coles
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - James Thompson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - Katie L. Horton
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - Robert A. Hirst
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK; (R.A.H.); (G.M.W.); (C.O.)
| | - Paul Griffin
- Paediatric Respiratory department, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; (P.G.); (C.H.)
| | - Gwyneth M. Williams
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK; (R.A.H.); (G.M.W.); (C.O.)
| | - Patricia Goggin
- Biomedical Imaging Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (P.G.); (R.D.)
| | - Regan Doherty
- Biomedical Imaging Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (P.G.); (R.D.)
| | - Peter M. Lackie
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
- Biomedical Imaging Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (P.G.); (R.D.)
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - Woolf T. Walker
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
| | - Christopher O’Callaghan
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester LE2 7LX, UK; (R.A.H.); (G.M.W.); (C.O.)
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Claire Hogg
- Paediatric Respiratory department, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; (P.G.); (C.H.)
| | - Jane S. Lucas
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - Cornelia Blume
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
| | - Claire L. Jackson
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (J.L.C.); (J.T.); (A.H.); (W.T.W.)
- School of Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton SO16 6YD, UK; (K.L.H.); (P.M.L.)
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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.
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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
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Abstract
Primary ciliary dyskinesia (PCD) is an inherited disorder of clinical and genetic heterogeneity resulting from mutations in genes involved in the transport, assembly and function of motile cilia. The resulting impairment in mucociliary clearance means patients suffer from chronic progressive lung disease, bronchiectasis, rhinosinusitis and middle ear disease. Subfertility is common to both male and female patients. Situs abnormalities occur in around half of patients, with a subgroup suffering more complex situs arrangements where congenital heart defects or other organ abnormalities frequently coexist. Variations from the classical PCD phenotype are increasingly recognised where overlapping features across a range of motile and nonmotile ciliopathies are redefining our approach to both diagnosis and management of these complex conditions. PCD offers an ideal opportunity for direct visualisation of ciliary function and structure, following nasal brush biopsy, allowing opportunities for researchers to directly interrogate the downstream impact of loss of function mutations. In turn, this has led to rapid advances in the development of new diagnostic tests. These advances mean that PCD is an excellent disease model for understanding the genetic and mechanistic causes of the clinical phenotype for all respiratory ciliopathies. Furthermore, the overlapping role of motile ciliary defects in a wider set of complex and syndromic disorders related to loss of function mutations in primary, nonmotile cilia has been recognised. As we better understand the role of ciliary defects in a broad spectrum of diseases, we should aim to map out a framework through which we can identify, diagnose and treat all respiratory ciliopathies. Key points Primary ciliary dyskinesia is just one of a group of conditions where a heterogeneous array of genetic mutations affect the assembly or structure of motile cilia.Overlapping phenotypes between motile and nonmotile ciliopathies are redefining the diagnostic and therapeutic approach to encompass all ciliopathy patients with a respiratory phenotype.An extended diagnostic algorithm may be required to capture the majority of cases with a respiratory ciliopathy, including patients with syndromic ciliopathies.The terminology around disorders of motile cilia is becoming more descriptive to better reflect the heterogeneity and underlying disease mechanisms across the spectrum of respiratory ciliopathies. Educational aims To summarise the existing knowledge base around the disease mechanisms for respiratory ciliopathies, including primary ciliary dyskinesia (PCD).To explore and understand the reasons for changing terminology around respiratory ciliopathies.To emphasise key messages around the diagnosis and treatment of all ciliopathies.Diagnosing PCD is complex and time consuming, and there is no single stand-alone test that can confirm or exclude a diagnosis in all cases.
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Affiliation(s)
| | - Claire Hogg
- Royal Brompton Hospital, London, UK.,Paediatric Respiratory Medicine, Imperial College London, London, UK
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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.
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Suzaki I, Hirano K, Arai S, Maruyama Y, Mizuyoshi T, Tokudome T, Fujii N, Kobayashi H. Primary Ciliary Dyskinesia with Refractory Chronic Rhinosinusitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923270. [PMID: 32862191 PMCID: PMC7483516 DOI: 10.12659/ajcr.923270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 49-year-old Final Diagnosis: Situs inversus Symptoms: Cough • nasal congestion • nasal obstruction Medication:— Clinical Procedure: — Specialty: Otolaryngology
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Affiliation(s)
- Isao Suzaki
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Sawa Arai
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Yuki Maruyama
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Tomomi Mizuyoshi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Takatoshi Tokudome
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Naokazu Fujii
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, School of Medicine, Showa University, Tokyo, Japan
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Poeta M, Borrelli M, Santamaria F. Azithromycin for primary ciliary dyskinesia: a milestone. THE LANCET. RESPIRATORY MEDICINE 2020; 8:429-430. [PMID: 32380064 DOI: 10.1016/s2213-2600(20)30100-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Marco Poeta
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, 80131 Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, 80131 Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, 80131 Naples, Italy.
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Shoemark A, Boon M, Brochhausen C, Bukowy-Bieryllo Z, De Santi MM, Goggin P, Griffin P, Hegele RG, Hirst RA, Leigh MW, Lupton A, MacKenney K, Omran H, Pache JC, Pinto A, Reinholt FP, Schroeder J, Yiallouros P, Escudier E. International consensus guideline for reporting transmission electron microscopy results in the diagnosis of primary ciliary dyskinesia (BEAT PCD TEM Criteria). Eur Respir J 2020; 55:13993003.00725-2019. [PMID: 32060067 DOI: 10.1183/13993003.00725-2019] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/24/2020] [Indexed: 11/05/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a heterogeneous genetic condition. European and North American diagnostic guidelines recommend transmission electron microscopy (TEM) as one of a combination of tests to confirm a diagnosis. However, there is no definition of what constitutes a defect or consensus on reporting terminology. The aim of this project was to provide an internationally agreed ultrastructural classification for PCD diagnosis by TEM.A consensus guideline was developed by PCD electron microscopy experts representing 18 centres in 14 countries. An initial meeting and discussion were followed by a Delphi consensus process. The agreed guideline was then tested, modified and retested through exchange of samples and electron micrographs between the 18 diagnostic centres.The final guideline a) provides agreed terminology and a definition of Class 1 defects which are diagnostic for PCD; b) identifies Class 2 defects which can indicate a diagnosis of PCD in combination with other supporting evidence; c) describes features which should be included in a ciliary ultrastructure report to assist multidisciplinary diagnosis of PCD; and d) defines adequacy of a diagnostic sample.This tested and externally validated statement provides a clear guideline for the diagnosis of PCD by TEM which can be used to standardise diagnosis internationally.
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Affiliation(s)
- Amelia Shoemark
- Royal Brompton Hospital, London, UK.,School of Medicine, University of Dundee, Dundee, UK
| | - Mieke Boon
- Dept of Pediatrics, University Hospital Leuven, Leuven, Belgium
| | | | | | | | - Patricia Goggin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Griffin
- Royal Brompton Hospital, London, UK.,Royal Childrens Hospital, Melbourne, Australia
| | - Richard G Hegele
- Hospital for Sick Children-University of Toronto, Toronto, ON, Canada
| | - Robert A Hirst
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Margaret W Leigh
- Dept of Pediatrics and Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Alison Lupton
- Pathology Dept, Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK
| | - Karen MacKenney
- NSW Health Pathology, Concord Repatriation General Hospital, Sydney, Australia
| | - Heymut Omran
- Dept of Pediatrics, University Hospital Muenster, Muenster, Germany
| | | | | | | | - Josep Schroeder
- Institute of Pathology, University Regensburg, Regensberg, Germany
| | | | - Estelle Escudier
- Sorbonne Université, Faculté de Médecine, INSERM UMR_S933, (APHP) Assistance Publique Hôpitaux de Paris and CHIC (Centre Hospitalier Intercommunal de Créteil), Paris, France
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